University of Minnesota School of Social Work Syllabus

SW 8806-Health and Mental Health Policy

Part I: Course information

SW 8806-Health and Mental Health Policy 2 credits Faculty contact:

Name: Email: Phone: Office Location:

Course descriptions: a. Short Version:

Health & health care policy in the U. S. is currently undergoing historic reforms. This course equips students to critically engage in health & mental health policy debate, analysis, development, and implementation, all of which are crucial to competent, ethical, and socially just SW practice.

b. Long Description: Health and health care policy in the U. S. is currently undergoing historic reforms. Professionals, legislators, government officials, policy analysts, interest groups, and citizens have been embroiled in complex debates about critical issues related to health and mental health policy, culminating in the 2010 final passage of the Patient Protection and Affordable Care Act. Debates continue, regarding vital issues of health care costs, financing, access, delivery systems, and the quality of care. Approximately 40% of social workers are directly employed in the fields of health and mental health, however, health and mental health issues and policies affect all fields of social work practice. Social workers comprise the largest group of professionally trained mental health providers in the U. S., conducting more than half of counseling and therapy services. This policy course equips students to critically engage in health and mental health policy debate, analysis, development, and implementation, all of which are crucial to competent, ethical, and socially just social work practice.

Pre-requisites: 1. This is an advanced social work class, and the material presented in this class is at an advanced

level. Social Work students enrolled in this course should have completed the foundation classes listed below, or have advanced standing status.

SW 5051 - Human Behavior and the Social Environment SW 5801 - Policies and Programs in American Social Welfare SW 8151 - Social Work Practice Methods: Individuals and Systems SW 8152 - Social Work Practice Methods: Families and Groups SW 8153 - Models of Community Intervention SW 8841 - Social Work Research Methods

2. If you are not a Social Work student, you need permission of the instructor

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Clinical Licensure Hours:

This course contains some clinical content, as required by the Minnesota Board of Social Work for eligibility for the Licensed Independent Clinical Social Worker (LICSW). The number of hours in each required category is listed below:

Area Differential Diagnosis

Assessment based treatment planning

Clinical Intervention Methods

Evaluation methodologies

SW values and ethics

Culturally specific clinical assessment

Other areas

Hours 0 0 0 2 28 0 0 Part II: Course outcomes Course Objectives: Upon successful completion of the course, students will:

1. Analyze and understand the current health and mental health care reform efforts and controversies in the U.S and Minnesota;

2. Understand the major organizational and financing characteristics of the health and mental health care systems in the United States;

3. Be informed about health and mental health care expenditures, delivery systems, and outcomes in the United States as well as other industrialized countries;

4. Recognize and appreciate the significance of social, psychological, behavioral, cultural, economic, and political factors in relation to health and mental health status and access to care;

5. Be aware of and analyze the economic, social, and political forces that shape health and mental health policies on the federal, state, local, and provider levels;

6. Appreciate consumer and advocacy groups’ perspectives and contributions to an array of past, current, and emerging health and mental health policies;

7. Understand the implications of health and mental health policies for social work practice, program development and management;

8. Be knowledgeable about current policy debates and developments, including their affect on the health and health care of diverse populations;

9. Be able to thoroughly and critically analyze health and mental health policies.

Social Work Practice Competencies Successful completion of this concentration course implies that the student has achieved competency in the following advanced practice behaviors:

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Competency: 2.1.2 – Apply social work ethical principles to guide professional practice

Social workers have an obligation to conduct themselves ethically and to engage in ethical decision-making. Social workers are knowledgeable about the value base of the profession, its ethical standards, and relevant law. Social workers:

Practice Behavior Covered in class through (i.e., activity, reading, content) Assessed

• Identify and analyze value-based and ethical dilemmas that arise in their area of practice, using professional codes of ethical standards and through appropriate professional consultation.

Yes Policy Analysis

Competency: 2.1.3 – Apply critical thinking to inform and communicate professional judgments Social workers are knowledgeable about the principles of logic, scientific inquiry, and reasoned discernment. They use critical thinking augmented by creativity and curiosity. Critical thinking also requires the synthesis and communication of relevant information. Social workers:

Practice Behaviors Covered in class through (i.e., activity, reading, content) Assessed

• Identify and synthesize multiple sources of knowledge to understand policy and practice issues related to their area of practice.

Yes Policy Analysis

EP 2.1.5 – Advance human rights and social and economic justice Each person, regardless of position in society, has basic human rights, such as freedom, safety, privacy, an adequate standard of living, health care, and education. Social workers recognize the global interconnections of oppression and are knowledgeable about theories of justice and strategies to promote human and civil rights. Social work incorporates social justice practices in organizations, institutions, and society to ensure that these basic human rights are distributed equitably and without prejudice. Social workers:

Practice Behaviors Covered in class through (i.e., activity, reading, content) Assessed

• Gain a full comprehension about disparities and their development, contribute to knowledge about institutional barriers to equality and apply concentration-appropriate strategies to advance social and economic justice.

Yes YES

Competency: 2.1.8 – Engage in policy practice to advance social and economic well-being Social work practitioners understand that policy affects service delivery, and they actively engage in policy practice. Social workers know the history and current structures of social policies and services; the role of policy in service delivery; and the role of practice in policy development. Social workers:

Practice Behavior Covered in class through (i.e., activity, reading, content) Assessed

• Understand, compare, analyze, formulate and advocate for policies in an area of practice

Yes Policy Analysis

Competency: 2.1.9 – Respond to contexts that shape practice Social workers are informed, resourceful, and proactive in responding to evolving organizational,

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community, and societal contexts at all levels of practice. Social workers recognize that the context of practice is dynamic, and use knowledge and skill to respond proactively. Social workers:

Practice Behavior Covered in class through (i.e., activity, reading, content) Assessed

• Assess the impact of historical and contemporary contexts on practice and policy in their area of practice.

Yes Policy Analysis

• Are responsive to dynamic changes in society and in their areas of practice.

Yes Policy Brief

• Organize and advocate with community members, program participants, service providers, community organizations, policy makers and the public to improve practice and service delivery in their area of practice.

Yes Policy Analysis

Part III: Course requirements Required Texts and Readings Moniz, C. and Gorin, S. (2010). Health and mental health care policy – a biopsychosocial perspective

(3rd Ed.). Boston: Allyn and Bacon. In addition, each student will select and read one of the following books: Angell, M. (2005). The truth about the drug companies – How they deceive us and what to do about it

(Revised edition). New York: Random House Potter, W. (2010). Deadly spin: An insurance company insider speaks out on how corporate pr is killing

health care and deceiving Americans. New York: Bloomsbury Press. Reid, T.R. (2009). The healing of America – A global quest for better, cheaper, and fairer health care.

New York: Penguin Press. Sullivan, K. (2006). The health care mess – How we got into it and how we’ll get out of it. Bloomington,

IN: AuthorHouse Torrey, E.F. (2008). The insanity offense – How America’s failure to treat the seriously mentally ill

endangers its citizens. New York: W.W. Norton and Co. Whitaker, R. (2002). Mad in America – Bad science, bad medicine, and the enduring treatment of the

mentally ill. Cambridge, MA: Perseus Books All other required readings listed in the syllabus are available online. It is the responsibility of each student to access these readings. Additional online required readings will be added throughout the semester to keep abreast of unfolding policy issues and debates and to accompany student presentations and guest speakers.

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Teaching and learning methods in this course include lecture; weekly “hot topic” reviews and discussion; small group assignments, presentations, and discussions; class exercises; guest speakers; audio/video presentations; short quizzes; assignments presented orally and in writing; respondent panels; and a take-home exam. Course Assignments and Grading Requirement Due Date ] Percent of Grade Participation Every week 6 In-Class Quiz #1 [Week 4] 8 In-Class Quiz #2 [Week 7] 8 Take-Home Essay Exam Due On or before 25 [based on selected book] [Week 9]

Class Discussion of Selected Books [Week 10] Part of class participation Quiz #3 [Week 11] 8

[administered online] Small group poster presentations: [Week 11] 10 Health Disparities Policy Analysis – Parts I & II On or before 10 Problem Analysis & Historical [Week 13] Context Critique of another student’s Finals week 5 Policy analysis Policy Analysis – Complete Project Finals week 30* (*includes 10 pts.

for Parts I & II) ____________________________________________________________________ Detailed directions for each required assignment will be handed out and discussed in class. Grading Scale A = 95 –100 A - = 90 – 94 B+ = 87 – 89 B = 84 – 86 B - = 80 – 83

C+ = 77 – 79 C = 74 – 76 C - = 70 – 73 D + = 68 – 69 D = 66 – 67

F = 65 and below

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Course Policies

There are many University and School of Social Work policies that govern this course. Please go to http://www.cehd.umn.edu/ssw/Documents/SSWCoursePolicies.pdf to see a complete description of all the policies.

Part IV: Course content

[Note: This is a dynamic time in the history and development of health policy in the United States. Throughout the course, we will stay current with issues as they unfold in Congress, the Courts, and the State legislature. Therefore, topics, readings, and the course flow likely will be altered somewhat as relevant issues and readings emerge through the semester] [Week 1] Topics: Introductions Overview and introduction to course and course assignments An overview of The Patient Protection and Affordable Health Care Act (2010) - Health Care Reform Reading: Henry J. Kaiser Family Foundation (2011). Health Care Reform: The Basics (click on tab) http://healthreform.kff.org/ [Note: We will refer to this excellent website throughout the semester as needed. You will find it useful to your own projects] Video: SICKO A documentary film by Michael Moore (2007) [View outside class time] Task: As you watch SICKO, take note of all the problems and issues with health care in the U.S.

that the film suggests or addresses. As you watch the film, be aware that the stories/cases presented involve people who have health insurance.

[Week 2] Topics: What is health/illness? What is mental health? What is mental illness? Approaches to health and health policy: the biopsychosocial perspective What determines good health?

Inequality in health: Social determinants of health

The health gradient

Important federal government mental health reports

Discussion of policy analysis project assignment

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Conducting advanced policy related research (One-half of class time)

Guest Speaker: Social Science Reference Librarian, Magrath Library, St. Paul Campus

Video Clip: Sir Michael Marmot, interviewed on PBS’s Newshour, regarding his research about

inequality and health discussed in your readings Readings: Moniz and Gorin, Chapter 1, Models of Health and Health Policy Moniz and Gorin, Chapter 9, Looking Beyond Health Care

U.S. Department of Health and Human Services (1999). Mental health: A report of the Surgeon General – Chapter 1, Introduction and themes. Rockville, MD: DHHS, SAMHSA, CMHS, NIH, NIMH.

Available online: http://www.surgeongeneral.gov/library/mentalhealth/home.html [Note: Read pp. 3-9 of Chapter 1 in particular, but look at the rest. Other chapters of this report may be read later in the course and the report may be a good resource for you]

President’s New Freedom Commission on Mental Health (2003). Achieving the promise: Transforming mental health care in America. Executive Summary (pp. 1-18 in actual report) and Goal 1: Americans understand that mental health is essential to overall health. (pp. 19-26 in actual report). Available online: http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Public_Policy/New_Freedom_Commission/Default1169.htm

[Note: Other parts of this report may be read later in the course and it may also be a good resource for you]

[Week 3]

Topics: The history of U.S. health and mental health policy and delivery systems

An overview of U.S. and Minnesota health care costs, quality, access and current dilemmas Recent reports related to health care in Minnesota

Readings: Moniz and Gorin, Chapter 2, The Failure to Establish National Health

Insurance: 1865-1946

A History of Overhauling Health Care (Multimedia timeline from the New

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York Times [Note: As you read the first chapters in your text, follow along and read this excellent multimedia timeline for additional information and pictures] http://www.nytimes.com/interactive/2009/07/19/us/politics/20090717_HEALTH_TIMELINE.html

Report of the Minnesota Citizens Forum on Health Care Costs (2004).

To be distributed by course Moodle site

[Skim executive summary, pages ESi-ESvii. Other parts of this report may be read later in the course and it may also be a good resource for you in other ways]

Physicians’ Plan for a Healthy Minnesota – The MMA’s Proposal for

Health Care Reform (January, 2005). The Report of the Minnesota Medical Association Health Care Reform Task Force [Read sections in color in .pdf file on course Moodle site]

Health Care Reform Task Force (2008). Recommendations submitted to

Governor Tim Pawlenty (pp. 1-19) [Available on Moodle site] ____________________________________________________________________ [Week 4] Topics: The history of U.S. health and mental health policy and

delivery systems (continued) An overview of U.S. health care costs, quality, access and current dilemmas (continued)

Video: Money Driven Medicine (2009) [View outside class time] Readings: Moniz and Gorin, Chapter 3, The Emergence of Employment-Based

Insurance and Managed Care: 1943 – Present

A History of Overhauling Health Care (Multimedia timeline from the New York Times [Note: As you read the first chapters in your text, follow along and read this excellent multimedia timeline] http://www.nytimes.com/interactive/2009/07/19/us/politics/20090717_HEALTH_TIMELINE.html

___________________________________________________________________ [Week 5] Topics: Access to health care

The insured / the uninsured / the underinsured Utilization of services Racial, ethnic, gender, and age disparities in access

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Continuing examination of the Patient Protection and Affordable Care Act

Video: Lifeline (Segment from 60 Minutes) OR Critical Condition Readings: Moniz and Gorin, Chapter 4, Access to Care Kaiser Family Foundation (2011). The Uninsured-A Primer: Key Facts about Americans without Health Insurance. http://www.kff.org/uninsured/upload/7451-07.pdf Henry J. Kaiser Family Foundation (2011). Health Care Reform http://healthreform.kff.org/ [Week 6] Topics: Financing health care (Part I) Medicare: Funding, coverage, and controversies Video: History of Medicare Readings: Moniz and Gorin, Chapter 6, Medicare and Medicaid, (pp.137-146 only) Henry J.Kaiser Family Foundation (2010) Medicare: A Primer http://www.kff.org/medicare/upload/7615-03.pdf ______________________________________________________________________ [Week 7] Topic: Financing health care (Part II)

Medicaid: Funding, coverage, issues, and controversies Children’s Health Insurance Program (CHIP)

Video: History of Medicaid

Readings: Moniz and Gorin, Chapter 6, Medicare and Medicaid (pp. 146 – 163 only) Henry J. Kaiser Family Foundation (2010). Medicaid: A Primer http://www.kff.org/medicaid/upload/7334-04.pdf _____________________________________________________________________ [Week 8] Topic: From Personal Tragedy to Public Policy: The Story of Postpartum Depression Education Legislation in Minnesota Guests: Ruth Ener and Toran Ener (Family members of Mine Ener who suffered from

postpartum psychosis and killed her daughter and herself in St. Paul in 2003. The family successfully advocated in the MN Legislature (2005 Session) for a bill requiring that women giving birth receive educational information about postpartum depression.

Readings: What is postpartum depression? [Class Handout- will receive by e-mail]

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How A Bill Becomes a Law in Minnesota

http://www.leg.state.mn.us/leg/howbill.asp [Week 9] Topics: Discussion of Books [selected by individual students from among a list of 5-6 books given to them at the beginning of the course] Class time for work on group disparities projects Readings: No additional readings this week ______________________________________________________________________ [Week 10] Topic: Financing health care (Part III)

Managed Care/Managed Competition: Basic concepts, evolution, and Controversies

Health Care Financing and Delivery in Other Industrialized Countries Video: Frontline: Sick Around the World [View outside class time] Readings: Moniz and Gorin, Chapter 5, The Growth and Development of Managed

Care (pp. 105 – 132) _____________________________________________________________________ [Week 11] Topic: Disparities in health – Small Group Poster Presentations Readings: Moniz and Gorin, Chapter 7, Disparities in Health: People of Color

Moniz and Gorin, Chapter 8, Disparities in Health: Gender and Age- Based Differences Additional readings selected by students relevant to the health disparities they are examining

[Week 12] Topics: The Minnesota Children’s Mental Health Act : From Policy to Practice Guest Speaker: Mental Health Consultant Children’s Mental Health Division Minnesota Department of Health and Human Services Readings: Minnesota Comprehensive Children’s Mental Health Act. (2008)

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Chapter 245.487 to 245.4889 Minnesota Statutes. ______________________________________________________________________ [Week 13] Topics: Mental Health issues in the MN legislative session

Where should U.S. health and mental health policy go from here? Guest: Executive Director, National Alliance on Mental Illness – Minnesota (NAMI-MN) Readings: Readings relevant to current legislative session will be assigned Moniz and Gorin, Chapter 9, Looking Beyond Health Care,

pp. 227-237 [reread] [Week 14] Policy Project Presentations and Critiques [Week 15] Policy Project Presentations and Critiques ______________________________________________________________________ Finals Week Final Policy Analysis Project Due Additional Bibliography Almgren, G. (2007). Health care politics, policy and services: A social justice analysis. New York: Springer Publishing Co. Angell, M. (2005). The truth about the drug companies – How they deceive us and what to do about it

(Revised edition). New York: Random House Bardach, E. (2009). A practical guide for policy analysis: The eightfold path to more effective problem

solving (3rd ed.) Washington, D.C.: CQ Press. Grob, G. N. (1994). The mad among us: A history of the care of America's mentally ill. New York: The

Free Press. Kelly, T. A. (2009). Healing the broken mind: Transforming America's failed mental health system. New

York: New York University Press Mahar, M. (2006). Money driven medicine: The real reasons health care costs so much. New York:

Harper Collins Mechanic, D. (2007). Mental health and social policy: Beyond managed care (5th ed.) New York: Allyn and Bacon Potter, W. (2010). Deadly spin: An insurance company insider speaks out on how corporate pr is killing

health care and deceiving Americans. New York: Bloomsbury Press. Reid, T.R. (2009). The healing of America – A global quest for better, cheaper, and fairer health care.

New York: Penguin Press.

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Rosenberg, J. and Rosenberg, S. (Eds.) (2006). Community mental health: Challenges for the 21st century. New York: Routledge/ Taylor and Francis Group

Sullivan, K. (2006). The health care mess – How we got into it and how we’ll get out of it. Bloomington, IN: Author House

Torrey, E.F. (2008). The insanity offense – How America’s failure to treat the seriously mentally ill endangers its citizens. New York: W.W. Norton and Co.

Washington Post Staff (2010). Landmark - The inside story of America's new health-care law and what it means for all of us. New York: Public Affairs/Perseus

Whitaker, R. (2010). Anatomy of an epidemic: Magic bullets, psychiatric drugs, and teh astonishing rise of mental illness in America. New York: Crown Publishers

Whitaker, R. (2002). Mad in America – Bad science, bad medicine, and the enduring treatment of the mentally ill. Cambridge, MA: Perseus Books

Selected Essential Websites: Henry J. Kaiser Family Foundation. www.kff.org National Alliance on Mental Illness. http://nami.org/ Health Beat- A Project of the Century Foundation. Blog written by Maggie Mahar, author of Money

Driven Medicine. www.healthbeatblog.org U.S. Department of Health and Human Services. http://www.hhs.gov Minnesota Department of Human Services http://www.dhs.state.mn.us/main Centers for Disease Control http://www.cdc.gov/ World Health Organization http://www.who.int/en/ Organization for Economic Cooperation and Development (OECD) http://www.oecd.org