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NOVEMBER/DECEMBER 2011

N AS W - V I R G I N I A neWs the bi-monthly newsletter from the national association of social Workers – Virginia chapter featuring chapter updates, legislative issues and information on continuing education training.

INSIDE ISSUE

Meet the conference speakers

“As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.” – John Fitzgerald Kennedy

Bureaucractic hurdles restrict essential Mental health serVices froM Virginia youth & their faMilies BecoMe a sponsor of nasW-Virginia 2012 annual conference legal deVelopMents in lgBt faMily rights health insurance, hippa and client priVacy

Wishing our members and their families the happiest of holidays. NASW-Virginia

NASW www.naswva.org

| VIRGINIA CHAPTER


TABLE OF contents Bureaucratic Hurdles Restrict Essential Mental Health Services from Virginia Youth & Their Families PG 6 Meet the Conference Speakers

PG 8

Become A Sponsor of NASW-Virginia 2012 Annual Conference PG 10

Legal Developments in LGBT Family Rights PG 11 Health Insurance, HIPAA and Client Privacy PG 15 Welcome New Members Poster Session

PG 19

PG 20

From the president’s pen Virginia licensure update Mary Sasser, LCSW, MPA President, NASWVA denials of lcsW applicants NASWVA depends on the voice of our members, who represent over 3000 members throughout the state, to bring forth legal and policy concerns that Mary Sasser, LCSW are impacting them. Over the course of the past year or so, we have been President hearing statewide concerns regarding licensure difficulties. Specifically, we have heard from many sources that growing numbers of social workers have been denied in their licensure application process. Reasons for denial are varied, but generally include denials due to insufficient clinical work, inadequate supervision, inadequate course work, and poor documentation. In response, NASWVA has taken a number of steps, and will continue to act in an effort to advocate for applicants and educate our members. regulatory changes To understand this current state of increased denials, it is important to understand the regulatory environment in which these changes were initiated. In November 2008, the Virginia Board of Social Work revised the Regulations Governing the Practice of Social Work, and included a requirement that any person wishing to pursue supervision for licensure provide a supervisory contract for preapproval by the Board of Social work before beginning such supervision. Since the inception of the regulatory changes, some social workers have had their supervisory contract for proposed supervision denied. Even persons who completed supervision prior to these regulatory changes are being denied as well. Social workers have been denied across settings, such as child welfare, hospitals, nursing homes, home health, schools and others. In some cases, supervisors who have been teaching supervisees for many years have also been denied. In response to inquiries, the Virginia Board of Social Work published guidance document #14010 on Supervised Experience for Clinical Social Work Licensure http://www.dhp.virginia.gov/social/default.htm. NASW VIRGINIA CHAPTER neWs 2


In this document, it states the supervising LCSW must assume responsibility for the social work activities of the supervisee and must document that the supervisee is providing clinical social work services as defined in regulation 18VAC140-20-10 as: • Performing assessments • Diagnosing (based on a recognized manual of mental and emotional disorders or recognized system of problem definition), and • Providing psychotherapy and counseling (for mental disorders, substance abuse, marriage and family dysfunction, and problems caused by social and psychological stress or health impairment) nasWVa response In an effort to better understand this trend, NASWVA completed a licensure survey this year of our members, and over 900 social workers responded. Of the responses, 263 had applied for licensure in the past three years, and 40 had been denied. 95% of persons denied expressed some or great surprise about this decision. One third reported they did not know the reason for denial, and 45% indicated their supervision did not meet the Board’s requirements. While nearly 75% of all respondents reported being familiar with the licensure requirements, over half expressed concern over the perceived changes in licensure requirements and/or the way in which the Board is interpreting them. In June, NASWVA participated in a meeting with social work leaders from around the state to discuss the future of the profession in Virginia. Attendees included leadership from the Schools of Social Work of Virginia Commonwealth University, Norfolk State University, James Madison University, George Mason University and Ferrum College. Also, attendees included the Association of Social Work Boards (ASWB), and the Virginia Society of Clinical Social Work (VSCSW). Among many issues, the group discussed the growing licensure concerns and potential dialogue with the Board of Social Work. During these discussions, NASWVA presented our data and general concerns as heard by our members. Board of social Work The Board of Social Work is appointed by the Governor of Virginia, and they are charged with protecting the public. It is ultimately their responsibility to ensure clinical licenses are granted only to those who can demonstrate core competencies as outlined in state regulations and laws governing practice. In July, NASWVA attended a Virginia Board of Social Work meeting, during which the results of the above noted June meeting were discussed. As a formal agenda item, the Board heard from the educators their challenges around implementing national curriculum changes as well as the Board’s regulatory licensure changes. Following this discussion, NASWVA then submitted public comment regarding post-graduate practice concerns as voiced to us by our members. nasWVa expressed concern that certain licensure applicants, case managers in particular, appear to be vulnerable in the licensure process today. NASWVA stated that we believe the core LCSW competencies, including clinical diagnostic and treatment skills, are essential skills widely used in a variety of practice settings, not just private practice or traditional mental health care. We also noted that literature shows that case management positions utilize a variety of diagnostic, preventative and treatment skills for purposes of assessing and treating vulnerable populations across a continuum of care. The Board of Social Work was very responsive and respectful to the NASWVA public comments, and appeared open to discussion regarding the clinical work of case management. At issue here NASW VIRGINIA CHAPTER neWs 3


is the definition of what constitutes clinical work. Persons not completing traditional weekly psychotherapy do appear to be vulnerable in this process. For example, if you are not doing traditional face to face hourly sessions, but are instead doing “on-the-spot” clinical interventions such as in one-time interactions with patients and families in healthcare arenas or social welfare arenas, you may need to strengthen your documentation. From what we can determine, the Board is looking for very specific evidence of clinical work, including concrete evidence that you are continually assessing, diagnosing and providing psychotherapy in all client hours counted for supervision. In the words of one Board member, hours “transporting a patient” are not considered clinical. Our challenge is that there may be scenarios in which you are in fact providing clinical assessments and treatments during nontraditional time intervals with your patients and families, such as in brief therapy or crisis intervention. If so, this needs to be clearly documented. The Board also cited difficulties with supervisors obviously copying generic applications from one applicant to the next, as well as applicants who submitted sketchy and/or possibly fabricated documentation. next steps NASWVA values your input. If you are continuing to have difficulties with your licensure process, we would like to know. We have learned of applicants who have succeeded after appealing their denied applications, sometimes after more than one appeal. We are still watching for trends, and will be in dialogue with key stakeholders regarding these concerns. In addition, NASWVA continues to dialogue with members regarding multilevel licensure, as this may be a possibility for Virginia’s social workers in the future as noted by the Board of Social Work. For additional information or to direct concerns, please contact Debra Riggs, Executive Director, at 804-2041339 or driggs@naswva.com.

CLASSIFIEDS

for November/December "Full time, sunlit office for lease in Springfield on Backlick Road near Fairfax County Parkway on bus line. Well maintained, professional building with foyer, located on second floor. Share space with 3 collegial Social Workers, includes waiting room, kitchen, and work area. Please call 703-921-0692, extension 104." Small mental health practice in Virginia Beach needs experienced psychotherapist, PhD, LCSW, LPC w/LMFT. Should be currently credentialed (or eligible) with Tricare, Anthem & others, Fax resume to (757) 424.5623

THE VIRGINIA SOCIETY FOR CLINICAL SOCIAL WORK December 16, 2011 8:00 AM – 4:00PM Williamsburg Hospitality House 415 Richmond Road • Williamsburg, Virginia 23185 A Symposium Sexual Violations: Prevention and Intervention with Victims, Survivors, Perpetrators, Therapists who are perpetrators, and the Community 1. Therapist as Perpetrators of Sexual Violation: Presenter Joseph G. Lynch LCSW, CSOTP Will explore the definition & extent of the problem: Why should we be concerned with the problem? What can we do about the problem? Legal Interventions; VSCSW Proposed Changes; and Request for Advocacy from all mental health professionals to effect the change effort. 2. Internet Pornography Problems: Presenter: Joseph G. Lynch LCSW, CSOTP Will explore the definition & extent of the problem in both adult and adolescent populations; Software that might assist client in dealing with impulses; Models of Therapy for Internet Pornography Addictions; and Expected future impact of Internet Pornography Addictions. 3. Sex Offender Risk Assessment: Presenter: David Boehm, LCSW, CSOTP Sex Offender Risk Assessment; Overview of Actuarial Risk Assessment for Adults and Adolescents, 6 Hours of Continuing Education Credit - Registration Deadline: November 10, 2011 www.vscsw.org NASW VIRGINIA CHAPTER neWs 4


nasW Virginia chapter districts

chapter Board of directors

district representatives

president Mary sasser, lcsW

Blue ridge district Juanita thorton tracy Meek

Vice president kathy Murphy-stephenson, lcsW

central district Molly cheek sherry confer, lcsW

secretary katherine prudden, lcsW

hampton roads district kevin Maskrey, lcsW sadie sheafe, ph.d

treasurer donilee-alexander goldsmith

northern Virginia district Joan thomas allyne Zappalla, lcsW

chapter office

Whitney young district Jennifer golladay stan remer

executive director debra riggs debrariggs@naswva.com

BsW student representative roger dever - gMu

continuing education coordinator sarah proctor sarahproctor@naswva.com

MsW student representative amy Bradshaw - Vcu

Marketing and Membership services coordinator cara crowley caracrowley@naswva.com

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Bureaucratic hurdles restrict essential Mental health services from Virginia youth & their families John Salay, LCSW NASW-VA Meber September 27, 2011 Views do not reflect the views of NASW-Virginia

The Department of Medical Assistance (the State Medicaid administrator) has asked up to 37,000 recipients of Community Mental Health Services to be assessed and approved by their local Community Service Board before they can continue in treatment effective July 18, 2011. These services include Intensive In-Home, Mental Health Support, and Therapeutic Day Treatment. The intent of this change was to better match services to a child’s needs while reducing spending. However, the net effect has been the withholding of essential mental health services, irrespective of need. The reason for this outcome is that this change occurred with no meaningful and transparent public policy debate or any opportunity for these citizens or their providers to voice their opinion or otherwise be represented. Medicaid identified $18 million in possible savings, or around 5% of total expenditures, from implementing this Assessment program. Anecdotal evidence indicates they have already achieved that amount of savings. Not necessarily from denying services to those who don’t need them, but from hindering a vulnerable population from getting the help that they need in a timely manner. If the bureaucratic barriers to treatment continue, it is possible that an additional 40% will be saved, representing services to 14,800 children and their families as well as countless service providers. This was surely not their intention. These services are known to be effective as evidenced by outcome measures and improved Client behaviors. The Clients in these programs suffer from very difficult economic, psychological, and social stressors that contribute to the development of severe behavioral and mental health issues which interfere with their ability to succeed at school or work. Let’s imagine someone who receives one of these Community Services; we will call him “Johnny”. Johnny is a seven year old who lives in subsidized housing with his grandmother. Johnny’s father is in prison and his mother is gone. When Johnny was four, he witnessed his older brother get shot to death and continues to become panicked for hours whenever there is a loud noise and he suffers from nightmares. As a result of these experiences, Johnny has already been suspended for fighting and may have to repeat the second grade. The grandmother asked for services from Johnny’s school and was referred to a licensed Day Treatment Social Worker who assessed him and submitted her report to the Medicaid contractor who also must approve the service. Johnny was approved for services and after six months in treatment, is beginning to do better at school, although he still wakes up at night screaming. The grandmother is now having great difficulty with navigating and getting him approved for continued services through this new assessment process. Although Johnny and his grandmother are fictional, their experience is not. NASW VIRGINIA CHAPTER neWs 6


Many clients have had difficulty with; getting through on the phone to the Service Boards, coordinating schedules to make appointments, arranging for transportation to the appointment, and being delayed once they are at the appointment. They are being told that they do not need the service that they requested. If they are approved for the requested service, they are then later being denied by the Medicaid contractor because the Service Board has not forwarded their paper work. It is time to bring this process into the light. The public deserves to have a policy debate. Are we really saving any money by making it so difficult for Johnny to receive services? Will we help him get through this difficult time so that he can function and grow up to contribute to society? What will happen to him without help? Will he go the way of his father or brother? What then the cost? What costs to society? It is time to re-evaluate the effectiveness of the Assessment Program, from the perspective of the Individuals needing these services. Could you imagine putting people through this process for their physical health? You would have to set up an appointment at the city clinic to earn approval for a procedure that your doctor already ordered as necessary. There is some indication that Medicaid is reviewing cases where services have already been denied because of roadblocks within the system. They are right to do this and should allow extensions for Individuals who could not be appropriately screened through the assessment process. In addition, the State and Medicaid should allow for public comment and debate over how we use resources for those who most need them before they make additional changes. Let’s do it right and give Johnny a chance to dream of a better future.

have something to say? say it with nasW-Va. Brenda exum: longtime nasW-Va Member and past Board Member NASW-Virginia would like to congratulate Brenda Exum. Ms. Exum was nominated by the non-profit organization Lee’s Friends as a candidate for the United Way of South Hampton Roads Minority Advisory Council's Board Member of the Year Award. Ms. Exum was honored along with other recipients during our Volunteer Awards Gala on Saturday October 8, 2011 as a part of their 20 year celebration of Diversified Excellence. NASW VIRGINIA CHAPTER neWs 7

Reach your colleagues throughout the Commonwealth! NASW-VA offers excellent member discounts and non-member rates for our newsletter, website, and job bank advertising. Promote your services. Find a tenet for empty office space. Find a quality employee for a job opening. For more information, visit the Marketplace section of our website, www.naswva.org, or call Cara Crowley at the Chapter office, (804) 204.1339 x203


The Universe Between Our Ears keynote speaker: Mr. paul aravich Professor of Pathology/Anatomy, Internal Medicine- Division of Geriatrics, and Physical Medicine & Rehabilitation at Eastern Virginia Medical School All attendees of the 2012 Keeping the Wheels Turnings Annual Conference will have the exclusive opportunity to take part in Dr. Aravich’s hands-on demonstration of the human brain. Participants will be eligible to respectfully handle human brains, hearts, and lungs donated to the “Virginia Anatomical Gift Act Program.” Dr. Aravich draws from his extensive neuroscience expertise and teaching experiences to explain the biological basis of behavior, the need to focus on the whole person, and the need to focus on the provider. • Winner of a Virginia State Council of Higher Education Outstanding Faculty Award. “The Commonwealth’s highest honor for faculty at Virginia’s public and private colleges and universities” for “superior accomplishments in teaching, research, and public service.” • Winner of an Alpha Omega Alpha Glaser Distinguished Teacher Award for “significant contributions to medical education” by medical school faculty in the United States and Canada. • Former Chair of the Virginia Brain Injury Council and its Ad Hoc Neurobehavioral Committee. • Former Chair of the Public Guardian and Conservator Advisory Board. • Former Member of the Committee on Neuroscience Literacy of the Society for Neuroscience. • Board Member: the Mary Buckley Foundation for brain injury survivors and their families. • Board Member: the I Need a Lighthouse Foundation for depression and suicide awareness in young people. • Board Members and former President: Alternatives, Inc., a nationally recognized service-learning organization to empower youth and promote civic engagement.

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Begin your Saturday Morning with an Inspirational Athlete plenary speaker: Mr. Brent rasmussen U.S. Paralympics Volleyball Team Captain and Nationally Recognized Professional Speaker Life is full of changes and it takes strength, a strong support system, and perseverance to handle what life throws at you. Brent Rasmussen had to be stronger than most when he was struck by a vehicle in 2002 resulting in the loss of his left foot, a shattered right ankle, and a 16’ rod in his left leg. As a new free agent to the Kansas City Royals his dreams were altered dramatically. Mr. Rasmussen will speak at the 2012 Keeping the Wheels Turning Annual Conference to address the importance of providing hope and perseverance.

Self Marketing Power: Branding Yourself as a Business of One preconference leadership institute speaker: Mr. Jeff Beals Award-winning author of Self Marketing Power: Branding Yourself as a Business of One, commercial real estate executive, radio-talk show host, television personality, and part-time college professor In order to make a difference in the community, find new career opportunities and to more efficiently fulfill your mission, today’s social workers and mental health professionals need to establish and promote their “personal brands.” The world in which you practice your profession and the job market in which you pursue it are both so crowded and noisy, making it difficult to stand out, serve stakeholders and attract volunteers. In this presentation, Jeff Beals, the international award–winning author of “Self Marketing Power,” shows you the secrets of personal branding and how to become a widely recognized and respected expert in your own sphere of interest in a tasteful and ethical manner. You will learn • • • • •

Three key philosophies of personal branding Eight rules of success How to develop your own self marketing expertise How to get better results from your networking efforts How to make your job easier using the media, social media, speaking and article writing

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Become a sponsor of nasW-Virginia 2012 annual conference hurry, spots are filling up!

The NASW-VA Annual Conference provides the premium opportunity to forge personal connections with hundreds of Virginia’s Social Workers and Mental Health Professionals at every level and from a myriad of practice settings. Conference Sponsorships come in a variety of prices and include marketing opportunities, including free advertising. Discounts are available for organizations that sponsored the 2011 Annual Conference. We’re also very excited to announce the 2012 Annual Conference will be held at the beautiful new Hilton Richmond Hotel & Spa at Short Pump. This hotel boasts centrally located exhibit space in the Conference foyer, which will ensure maximum foot traffic and multiple opportunities for every Sponsor to make priceless connections with all of our attendees. the 2012 application The 2012 Sponsorship Prospectus can be found on the NASW-VA Chapter website. To request a PDF or paper copy, please contact Marketing Coordinator, Cara Crowley, at (804) 204.1339 x203 or by e-mail at caracrowley@naswva.com apply now! Each sponsorship level has a limited number of tables, and they go fast! There are two easy ways to register – fill out the easy online application on the Chapter website or fill out the Sponsorship Application included in the Prospectus and return it along with payment by mail or fax.

interested in Becoming More involved? interested in networking? Join a specialty practice group! NASWVA is starting a clinical practice special interest group. We are looking for all members who are would like to be involved in this new endeavor. What is a SIG? A SIG is the acronym for Specialty Interest Group. This is a group of members of the association who are interested in networking, practices, and getting to know colleagues’. The clinical group will meet for the first time in October. All new members can be a part of how this new group will form, meet and communicate. Please call or email Debra Riggs at the chapter office and she will put you on the list. Her email is debrariggs@naswva.com, and her phone number is 804204-1339 ext 201. Looking forward to meeting you soon! NASW VIRGINIA CHAPTER neWs 10


legal developments in lgBt family rights Legal Developments in LGBT Family Rights Sherri Morgan, Associate Counsel, LDF and Office of Ethics & Professional Review, Amber Khan, Legal Researcher, and Carolyn I. Polowy, NASW General Counsel © september, 2011. national association of social Workers. all rights reserved. introduction There remain many barriers to full legal recognition of gay and lesbian couples’ relationships although this is an area of family law that is developing at a rapid pace. In recent years many cases have been litigated across the country addressing foster care and adoption, child custody rights, and same-sex marriage. Past NASW Legal Defense Fund Legal Issue of the Month articles have outlined earlier cases addressing these issues (NASW, 2006, 2008). NASW continues to be involved as a “friend of the court” to support the family relationships of same-sex couples and their children and this Legal Issue of the Month article provides an update on the status of state laws addressing these matters. same-sex Marriage According to the National Conference on State Legislatures, Massachusetts, Connecticut, Iowa, Vermont, New Hampshire, New York, and the District of Columbia currently issue marriage licenses to same-sex couples (NCSL, 2011). Actions by state legislatures and court decisions have prompted this change. For example, in Iowa it was the Iowa Supreme Court that struck down the statute limiting civil marriage to a man and a woman, as unconstitutional. The challenge to the statute had been successfully brought by same-sex couples against a county reporter for refusing to issue them marriage licenses (Varnum v. Brien, 763 N.W.2d 862 (Iowa, 2009)). New York also recognizes same-sex marriages from other states. Delaware, Hawaii, Illinois, New Jersey, and Rhode Island allow for civil unions, which provide state-level spousal rights to same-sex couples (NCSL, 2011). In New Jersey, this change was also prompted by a decision of the state’s high court. In Lewis v. Harris 188 N.J. 415 (NJ 2006), same-sex couples in NJ brought action against officials for refusing to issue marriage licenses, alleging it was a violation of their constitutional rights. NASW supported the plaintiffs, and argued that marriage inequality causes psychological and social harm to the couple and to their children (see NASW, 2006). The Supreme Court of New Jersey found that same sex marriage was not a fundamental right, however that same sex couples should be afforded the same rights and benefits as heterosexual married couples. The state of New Jersey then passed legislation recognizing civil unions in 2006. The same-sex couples brought another action seeking the enforcement of the earlier ruling and legislation, claiming they were still being denied equal rights. The Supreme Court of New Jersey denied the plaintiffs’ motion, but stated that the issues needed to be fully developed in the trial court, and didn’t reach the merits of the case (Lewis v. Harris, 202 N.J. 340 (NJ 2010)). Since the publication of the Legal Issue of the Month, Social Workers and Same Sex Marriage and Adoption, in 2006 more states have chosen to permit same-sex marriage. In 2009, Washington D.C. passed legislation allowing for same-sex marriage (NCSL, 2011; see also Jackson v. DC Board of Election and Ethics, 999 A.2d 89 (D.C. Court of Appeals, 2010)). In 2011, New York passed similar legislation, and in the same year Rhode Island passed legislation allowing for civil unions (NCSL, 2011). NASW VIRGINIA CHAPTER neWs 11


In a landmark California case, In re Marriage Cases, the California Supreme Court held that all people regardless of sexual orientation had a right to marry (In re Marriage Cases, 183 P.3d 384 (2008); see also NASW, 2008). In November of 2008, California residents approved Proposition 8, which amended the California Constitution to prohibit same-sex marriages (HRC, 2009). A lawsuit was then brought in Federal Court to prohibit enforcement of Proposition 8, arguing it was unconstitutional (HRC, 2009). NASW filed a friend of the court brief to support same-sex couples’ right to marry. The 9th Circuit Court of Appeals ruling on the case was very mixed. The Court did not dismiss the challenge, but neither did it find the initiative to be unconstitutional. Instead the Court certified a question to the California Supreme Court, to determine if the proponents of Proposition 8 had the authority to assert the state’s interest in this case. As of yet, there is no final decision in this case (Perry v. Schwarzenegger, 628 F.3d 1191 (9th Cir. 2011)). State courts have also addressed the constitutionality of bans on same-sex marriage. In Conaway v. Deane & Polyak , 401 Md. 219 (Md. 2007), a same sex couple brought action against a county clerk who refused to issue them a marriage license. The Maryland Court of Appeals held that there was not a fundamental due process right to marry a person of the same sex, and that a ban on same sex marriage was constitutional. On the other hand, in 2008, the Connecticut Supreme Court held that laws restricting marriage for same sex couples violated the state’s equal protection rights (Kerrigan v. Commissioner of Public Health, 289 Conn. 135, 957 A.2d 407 (Conn. 2008)). NASW filed amicus briefs supporting same-sex marriage in both cases. adoption/foster care Often courts will support the rights of same-sex couples to adopt or foster children, even when those same courts do not support same-sex marriages. For example, Maine does not issue marriage licenses to same-sex couples, nor does it recognize marriages of same-sex couples from other states (19-A Maine Rev. Stat. Ann. §701). However, in 2007 the Supreme Judicial Court of Maine upheld an unmarried same-sex couple’s right to file a joint petition for adoption, even though joint petitions were generally used by married couples (Adoption of M.A., et al., 930 A.2d 1088 ( Me. 2007)). Similarly the state of Florida does not recognize same-sex marriages. However, in Florida Department of Children and Families, 2010 WL 3655782 (Fla. Dist. Ct. App. 2010), the Florida Court of Appeals struck down a state statute that banned adoption by homosexual couples as unconstitutional and a violation of the state’s equal protection clause. In both cases, NASW filed friend of the court briefs to support the same-sex couples’ rights to adopt. The briefs highlighted the need to find suitable adoptive parents, and how sexual orientation is irrelevant to determining a person’s suitability as a parent. In 2009, the West Virginia Supreme Court of Appeals prevented a child from being removed from a foster home headed by parents of the same sex (Kutil and Hess v. Blake, 223 W.Va. 711 (W. Va. 2009)). The Circuit Court had ordered the child to be removed, and the foster parents sought a writ of prohibition to bar enforcement of the order. NASW supported the parents, and highlighted in the brief the research that shows that children raised by parents of the same sex are just as healthy as children raised by heterosexual couples, and that the circuit court’s holding would be contrary to the best interest of the child. The West Virginia Supreme Court granted the parents’ writ after an unsuccessful attempt by the child welfare agency to place the child with a heterosexual married couple. custody disputes Custody and visitation rights are to be decided by courts based on the ‘best interest of the child’ standard. However, in cases of parents of the same sex the issues may become more complicated. NASW VIRGINIA CHAPTER neWs 12


Often one parent is not biologically related to the child, nor is he/she the legal adoptive parent of the child. In such cases, the biological/adoptive parent may attempt to block the other parent’s access to the child once the couple’s relationship has dissolved. In 2008, the Maryland Court of Appeals heard such a case. In Janice M. v. Margaret K., 404 Md 661(Md. 2008), the former domestic partner of the biological mother sought custody and visitation with their child. The Court of Appeals of Maryland denied the former domestic partner’s request for custody or visitation, and held that de facto parent status was not recognized under Maryland law. In 2009, the Montana Supreme Court came to the opposite conclusion. In Kulstad v. Maniaci, 352 Mont. 513 (Mont. 2009), a same sex partner filed a petition to dissolve her common law marriage, and to receive a parenting interest in the children her partner had adopted. The adopted mother opposed the petition. The Montana Supreme Court applied state law which granted non-legal parents standing in custody cases when they established the existence of a parentchild relationship. In this case the Court found such a relationship existed, and granted the interest. Similarly, the Ohio Court of Appeals upheld a lower court’s decision to grant visitation to a biological mother’s former partner, where the children were born during the partnership (In re S.J.L., 2010 WL 3042394 (Ohio Ct. App. 2010); see also In re S.J.L., 2010 WL 3042394 (Ohio Ct. App. 2010)). In New York, the Court of Appeals also addressed whether the former partner of a biological mother had the right to seek custody and visitation with the children born during their civil union (Debra H. v. Janice R., 15 N.Y.3d 767 (N.Y. 2010)). The civil union occurred in Vermont, where the children were born. The Court held that under Vermont law the women were in a valid civil union, and a ‘partner’ is a parent for purposes of having standing to seek visitation and custody. NASW also filed friend of the court briefs in the above mentioned cases, informing the courts of the social science research which indicates that attachment relationships are formed between children and their non-biological parents, and arguing that it is in the best interests of the children to protect those relationships by permitting the parent to seek review in the courts. Rather than focusing on the qualitative relationship of the specific parents in a custody case, NASW’s position is based on providing both parents with the opportunity to present evidence about their parent-child relationship for consideration by the courts. Another case with NASW involvement arose in North Carolina, where the biological mother’s same-sex partner legally adopted their child. However, after the couple separated the biological mother filed a motion to invalidate the adoption (Boseman v. Jarrell, 364 N.C. 537 (NC 2009)). NASW filed a friend of the court brief supporting the finality of adoption and the adoptive mother’s parental rights. However, the Supreme Court of North Carolina held that the adoption decree was void, as the state adoption statute required that the biological parent’s rights be terminated by giving consent for another individual to adopt the child. The North Carolina Supreme Court has effectively barred partners of biological parents from adopting their children, leaving one of the parents with no legal rights in case of a separation from the biological parent. Permitting an adoption to be voided years after it is finalized raises implications that could be quite grave for children of same-sex couples. It is not yet clear whether other states will follow North Carolina’s rationale. In 2011, the Illinois Appellate Court had to answer a similar question while addressing whether to terminate a guardianship agreement (In Re T.P.S., 2011 WL 2472671 (Ill. App. Ct. 2011)). The biological mother of the child petitioned the court to terminate a guardianship agreement that made NASW VIRGINIA CHAPTER neWs 13


her former lesbian partner the co-guardian. The lower court found that the co-guardian did not have standing to oppose the biological mother’s petition. The Illinois Appellate Court reversed the decision, and remanded it back to the lower court to be decided upon the ‘best interest of the child’ standard, thus permitting the non-biological parent to provide evidence of the parent-child bond, for review by the court. conclusion The field of family law continues to change and evolve, particularly with respect to same-sex couples who are marrying, seeking to marry and/or raising children together. In recent years, more states have passed legislation or rendered court decisions giving legal recognition to same-sex marriages. State courts have also upheld the rights of parents who are in a same-sex relationship. However, many other states and state courts still do not recognize the rights of same-sex couples or parents, nor does federal law. NASW continues to support the right to marry, and for courts to determine custody matters based upon the ‘best interest of the child’ and the quality of the parent-child relationship rather than the sexual orientation of the parents. references 19-A Maine Rev. Stat. Ann. §701. Adoption of M.A., et al., 930 A.2d 1088 ( Me. 2007). Boseman v. Jarrell, 364 N.C. 537 (NC 2009)). Conaway v. Deane & Polyak, 401 Md. 219 (Md. 2007). Debra H. v. Janice R., 15 N.Y.3d 767 (N.Y. 2010). Florida Department of Children and Families, 2010 WL 3655782 (Fla. Dist. Ct. App. 2010). In re Marriage Cases, 183 P.3d 384 (2008). HRC (2009). California marriage/relationship recognition law. Human Rights Campaign. [Online]. Available at http://www.hrc.org/issues/453.htm. In Re T.P.S, 2011 WL 2472671 (Ill. App. Ct. 2011). In re S.J.L., 2010 WL 3042394 (Ohio Ct. App. 2010). Jackson v. DC Board of Election and Ethics, 999 A.2d 89 (D.C. Court of Appeals, 2010). Janice M. v. Margaret K., 404 Md. 661(Md. 2008). Kerrigan v. Commissioner of Public Health, 289 Conn. 135, 957 A.2d 407 (Conn. 2008). Kulstad v. Maniaci, 352 Mont. 513 (Mont. 2009). Kutil and Hess v. Blake, 223 W.Va. 711 (W. Va. 2009). Lewis v. Harris, 202 N.J. 340 (NJ 2010). Lewis v. Harris 188 N.J. 415 (NJ 2006). NASW (2008). Social workers and the California same-sex marriage cases. Legal Defense Fund, National Association of Social Workers. [Online]. Available at http://www.socialworkers.org/ldf/legal_issue/2008/200807.asp (accessible to NASW members). NASW (2006). Social workers and same-sex marriage and adoption. Legal Defense Fund, National Association of Social Workers. [Online]. Available at https://www.socialworkers.org/ldf/legal_issue/2006/200611.asp (accessible to NASW members). NCLS (2011). Same-sex marriage, civil unions and domestic partnerships. National Conference of State Legislatures. [Online]. Available at http://www.ncsl.org/default.aspx?tabid=16430. Perry v. Schwarzenegger, 628 F.3d 1191 (9th Cir. 2011). Varnum v. Brien, 763 N.W.2d 862 (Iowa, 2009).

The information contained in this article is provided as a service to members and the social work community for educational and information purposes only and does not constitute legal advice. We provide timely information, but we make no claims, promises or guarantees about the accuracy, completeness, or adequacy of the information contained in or linked to this document and its associated Web sites. Transmission of the information is not intended to create, and receipt does not constitute, a lawyer-client relationship between NASW, LDF, or the author(s) and you. NASW members and readers should not act based on the information provided in the LDF document. Laws and court interpretations change frequently. Legal advice must be tailored to the specific facts and circumstances of a particular case. Nothing reported herein should be used as a substitute for the advice of competent counsel. NASW VIRGINIA CHAPTER neWs 14


health insurance, hipaa and client privacy By Sherri Morgan, Associate Counsel, LDF and Office of Ethics & Professional Review, Carolyn I. Polowy, NASW General Counsel and Amber Khan, Legal Researcher ©2011 National Association of Social Workers. All Rights Reserved. Introduction Many social work clients depend on health insurance companies to cover the costs of their mental health treatment and, in return, many clinical social workers depend on reimbursement from health insurance companies for their income. In order to facilitate the claims and payment processes, health insurers generally require access to some information about the clients’ emotional or mental conditions and the progress of treatment. As insurers’ requests for confidential information have increased, social workers sometimes have experienced conflicts with the ethical and legal obligations to respect the privacy of their clients and to maintain confidentiality. This Legal Issue of the Month article will evaluate the effects on client privacy when social workers interact with health insurance companies and will focus on provisions of the Health Insurance Portability and Accessibility Act of 1996 (“HIPAA”) that provide mechanisms for protecting clients’ privacy. Background Health insurers, including Medicaid, Medicare and managed care organizations, continue to seek reductions in healthcare costs by reviewing providers’ claims to assure that the treatment provided was medically necessary and properly documented according to the insurer’s standards. During the claims process or even years later, for auditing purposes, an insurer may request detailed information about the client’s mental health symptoms, treatment, progress and prognosis, including clinical records of psychotherapy sessions. At times, the client and/or the clinical social worker may determine that an insurer’s request is so intrusive as to interfere with the treatment process or to violate client privacy rights. In order to determine what options are available for responding to requests for detailed client information a social worker may need to review federal health privacy standards, state laws concerning health privacy and social work practice, and ethical principles. HIPAA The privacy regulations which implement the Health Insurance Portability and Accessibility Act of 1996 (“HIPAA”) list the circumstances in which health care entities may disclose protected health information, and the circumstances in which they must disclose. Generally, HIPAA allows health care entities to disclose protected health information for purposes of “treatment, payment, or health care [business] operations” without client consent (45 CFR 164.506 (current through 2011)). This includes information disclosed by clinical social workers to health insurance companies to facilitate claims for payment. Although HIPAA allows the disclosure of information without consent for payment purposes, it does not prohibit health care providers from obtaining client consent in order to meet professional ethical standards, such as the NASW Code of Ethics, which does require consent before releasing confidential client information to insurers (NASW, 2008). With the client’s signed consent to release information, clinicians may complete health insurance claim forms and submit them to the insurer for reimbursement. From time to time, insurers may ask for some additional information to justify the continuation of treatment for a specific number of sessions and clinicians generally rely on the initial release form signed by the client as sufficient authorization to release the additional information. However, when an insurer insists on a copy of the clinician’s notes there are concerns as to whether the client’s expectations about privacy may be breached. NASW VIRGINIA CHAPTER neWs 15


At least three provisions within the HIPAA privacy regulations are available to protect client privacy from requests by insurers for more detailed clinical information than the client or practitioner believes is necessary: 1. Clients who self-pay may request that their health care practitioner not inform their health insurer and the practitioner is required to comply with this request, according to a HIPAA amendment included in the Health Information Technology for Economic and Clinical Health Act 42 U.S.C.S. § 17935 (2009). In this instance, clients with higher incomes can afford to “pay” for increased privacy by by-passing their available mental health insurance benefits, while lower income clients generally cannot afford this option. 2. Health insurers are subject to HIPAA’s “minimum necessary” requirement (as are providers). The insurer is required to limit its request for the disclosure of information to the minimum amount necessary for a particular purpose. However, the entity that is releasing the information (such as a clinical social worker) has the authority to determine whether the amount of information to be released is the “minimum necessary” (42 U.S.C.S. 17935(b)(2)). 3. A readily available option is for the clinical social worker/psychotherapist to create two folders for each client. The “medical record” would contain summary progress notes sufficient to document that clinical services were provided on specific dates, that the treatment was medically necessary and appropriate. The client’s detailed information about the content of sessions and the therapist’s own thoughts and analysis would be placed in a separate “psychotherapy notes” folder. Thus, when an insurer requests access to or a copy of the entire “medical record,” their staff will not have access to the psychotherapy notes. Psychotherapy Notes With a few exceptions, separately maintained psychotherapy notes may not be disclosed unless the client has signed a separate authorization form (45 CFR 164.506; 45 CFR 164.508 (current through 2011). HIPAA defines psychotherapy notes as, [N]otes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual's medical record. Psychotherapy notes excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: Diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date (45 CFR 164.501 (current through 2011)). Thus, the material that HIPAA “excludes” from psychotherapy notes is what would be included in the client’s primary clinical record (e.g. the HIPAA “medical record”), as well as insurance and payment information. A client cannot be required to sign an authorization to release the separate psychotherapy notes as a condition of “treatment, payment, enrollment in the health plan, or eligibility for benefits” (45 CFR 164.508). Thus, insurers are prohibited from coercing or pressuring clients to sign a consent to release psychotherapy notes and the information will remain protected from disclosure (Morgan, 2006).

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Minimum Necessary Standard Health care entities must generally abide by the HIPAA minimum necessary standard. Under HIPAA, “When using or disclosing protected health information or when requesting protected health information from another covered entity, a covered entity or business associate must make reasonable efforts to limit protected health information to the minimum necessary to accomplish the intended purpose of the use, disclosure, or request” (45 CFR 164.502 (current through 2011)). This standard applies to disclosures made for payment purposes, although there are a number of other exceptions to the rule. The minimum necessary provision is intended to provide the individual client with as much privacy as possible, even when providers disclose the individual’s protected health information to other entities, such as health insurance companies. Tension exists between consumer privacy advocates and the health insurance industry as to how much and what personal information health insurers should be able to access and use in the conduct of their business. In order to challenge an overly-broad or overly-detailed request for information from a health insurer, the practitioner may need to follow up with a contact to the insurer’s “HIPAA privacy officer” in writing, if attempts to communicate the concerns to the provider relations staff have been unsuccessful. The HITECH amendments to HIPAA indicate that the entity that is releasing information “shall” determine whether it is the minimum amount necessary. This provides practitioners with clear statutory authority to determine what information to release; however, it is unclear how insurers will respond in the event of conflicting views on how much clinical information is needed for claims processing, auditing and other insurance business activities. State Health Privacy Laws A number of states have provisions defining and protecting a health care practitioner’s personal notes. Different terms may be applied to that content and the type of privacy protection varies from state to state (Morgan and Polowy, 2001, Appendix II). For purposes of protecting client’s information from unnecessary disclosure to health insurers, it is advisable to follow the HIPAA standards for maintaining separate “psychotherapy notes.” Analysis and Conclusion Since the HIPAA privacy regulations were implemented eight years ago, there has been sufficient opportunity to evaluate the effectiveness of the “psychotherapy notes” provision and it has been a beneficial mechanism to protect clients’ privacy. Changing expectations about privacy in the wake of electronic health records and new modes of communication may heighten concerns about whether any confidential information can be adequately protected from disclosure. The limits on disclosure of separate psychotherapy notes are one of the few extra privacy protections provided in the HIPAA regulations. Although the use of separate notes is voluntary, it is highly recommended that clinical social workers utilize this mechanism if the social work practice or agency routinely files claims with health insurers. Even insurers with which a social worker has had a long and positive working relationship may conduct a random audit (often through an outside contractor) several years after treatment has terminated and request clients’ detailed clinical information. The needs of the insurer/auditor can be readily met while protecting client privacy, if psychotherapy notes were maintained separately. It is less clear how effectively the “minimum necessary” standard has been applied to protect clients’ privacy, as it is subject to widely varying interpretations between (and within) health care entities. Finally, the “self-pay” provision (noted in the numbered paragraph above) is effective to block insurers’ access to client information, but at a cost to the individual client and potentially to society, as it does not address the rights of those who cannot afford to pay for treatment out of pocket. NASW VIRGINIA CHAPTER neWs 17


References 45 CFR ยง 164.501 (current through 2011). 45 CFR ยง 164.502 (current through 2011). 45 CFR ยง 164.506 (current through 2011). 45 CFR ยง 164.508 (current through 2011). Morgan. S., et al. (2006). Social workers and psychotherapy notes. Legal Defense Fund, Legal Issue of the Month, National Association of Social Workers. [Online]. Available at https://www.socialworkers.org/ldf/legal_issue/2006/200606.asp (accessible to NASW members). Polowy, C., et al. (1997, 2011 edition pending). Client confidentiality and privileged communications. General Counsel Law Note, National Association of Social Workers. [Online]. Available to order at http://www.socialworkers.org/ldf/lawnotes/confidentiality.asp. Polowy, C. and Morgan, S. (2001). Social workers and clinical notes. General Counsel Law Note, National Association of Social Workers . [Online]. Available to order at http://www.socialworkers.org/ldf/lawnotes/notes.asp. 42 U.S.C.S. ยง 17935 (2009).

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“every man owes a part of his time and money to the business or industry in which he is engaged. no Man has a moral right to withhold his support from an organization that is striving to improve conditions within his sphere” - - president teddy roosevelt The Virginia Chapter would like to welcome our new members from across the state. We appreciate your choice to support your profession and advocate for social work. It takes a strong voice and we couldn’t do it without you.

Blue ridge Amanda Kanode Ann Pearce Brandon Rotenberry Brittany Deering Connie Hopkins central district Beverly Agness Angela McComber Angela Wallace Cristina Bares Theresa Duffey Julie Bass Ruth Cutler Maria Haltom Collin OVerby Meg Rapelye Scott Quarforth Shannon Lee

haMpton roads district Melda Pol Chistinia Beckett Gladys Medder Heather Zakrzewski Jennifer Muro Kelly Martin Elizabeth Monroe John Adams Sarah Foster Sydney Blydenburgh northern Virginia district Adrienne Sheard Alexandra Frerotte Allison Podlaskowich-Gomez Cecilia Brown Christine Fenton Jacqueline Charneco Joanna Aragon Melissa Marrow Megan Tisdelle Cynthia Clark Roger Dever Surina Amin Elizabeth Contreras

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poster session

NASW-VA 2012 Annual Conference Poster Session deadline: february 3, 2011 What is a poster session? Poster sessions are a forum for the exchange of information among conference attendees. They take place outside the programmed workshop sessions and are a way to communicate ideas, research and innovative programs or initiatives. Information is communicated via text, graphics, tables, charts, pictures, and verbal descriptions with the aim of quickly and easily presenting highlights of a program or research study. How and When Will the Posters Be Presented? The poster session will take place on Friday, March 9, 2012 at 3:30 pm during the Extended Networking Break at the NASW-VA Annual Conference held at the new Hilton Richmond Hotel & Spa at Short Pump. Presenters will be provided with a table upon which to set up a display of their research or program initiative, along with any additional information. Presenters are to be available during this time to talk about their research or program initiative. A specific presentation is not necessary. The winning poster will be presented at the Awards Luncheon on Saturday, March 10, 2012. Benefit of the NASW-VA Poster Session: • An opportunity for social workers and social work students to present their research or program initiatives. • An opportunity for social workers and social work students to enhance their skills in writing, presentation and scholarship. • An opportunity for social workers and social work students to disseminate professional ideas, to the larger social work community who participates in the conference. • An opportunity for social work students to learn more about their professional association, to learn more about the profession of social work, and to network with social work professionals. Eligibility and Requirements • Open to social workers and students currently enrolled in a BSW or MSW or PhD program. • Posters may be either: 1. Original research, or 2. Original program design/initiative • All submissions must be sent to NASW-VA postmarked no later than Friday, February 3, 2012. Accepted submissions will be contacted by email or phone as appropriate • All poster session proposals must include: o Title of poster o Name of the institution/college – for student proposals o Name(s) of person (s) presenting the poster note: Please indicate if more than one person wants to present this poster. Depending upon the number of posters accepted, more than one presenter may be allowed. NASW VIRGINIA CHAPTER neWs 20


o Names of those involved in the development of the project o A short (200-300 word) description of the project • For submissions by students, the student must be the primary author. The research or program development must be done in conjunction with, and under the supervision of, a social work faculty or a social work field instructor. The faculty or instructor must be a social worker, and may serve either as a supervisor on the project or as a co-author. o The faculty or field instructor does not need to attend the poster session/conference with the student, although they are welcome and encouraged to do so. The complimentary one-day conference registration, however, will only be provided to the main presenter of the poster Display Requirements • The poster should be on a tri-fold or easel style foam or poster board that is rigid and free standing. It should be able to stand unsupported on a display table. • Presenters are responsible for the set up and take down of their posters. • At minimum the poster should contain: the title, author(s), university/college affiliation if any, abstract, introduction, methods, and conclusion. • Poster size requirements will be provided upon selection for presentation.

nasW-Va: it’s election season! aimee perron seibert Virginia held its Republican and Democratic primaries on August 23 and we are now closing in on the General Election on November 8. All 140 General Assembly seats will be on the ballot. Republicans and Democrats have had divided control of the two-chamber legislature and the office of Governor since 2002. The Republicans in the House of Delegates are expected to maintain their strong majority. The major battleground in this year’s election is the Senate. The Democrats currently hold a 22-18 majority. However, the Virginia Senate Republican Caucus and Governor McDonnell are vigorously campaigning to retake the upper chamber and elect 21 Republican Senators. There is a strong chance the Republicans will seize control of both chambers. In the Senate campaigns, Republicans are running in 36 out of 40 districts. Democrats are only running in 27 of these districts. The political landscape may look much different during the 2012 General Assembly session. There would be new committee chairs, including Senate Finance and Senate Education and Health- two committees that frequently hear our issues. With your help, NASW-VA’s PACE committee is in the mix, giving contributions and attending fundraisers for candidates on both sides of the political aisle. We continue to thank legislators for all their support in passing our biggest legislative victory, Social Work Title Protection and educate candidates about the issues that matter most to social workers, including protecting the Commonwealth’s most vulnerable citizens in the crafting of a budget and keeping LCSW reimbursements rates the same. Regardless of the outcome on November 8, our goal is to have legislators who understand and support social workers in Virginia. You can find a complete listing of candidates in your area at http://www.vpap.org NASW VIRGINIA CHAPTER neWs 21


share your story Submission Date- 2.10.12 We honor those who are steadfast in their pursuit of professional excellence and commitment to the values of social work. The National Association of Social Workers (NASW) is the largest and most recognized membership organization of professional social workers in the world. Representing 155,000 members from 56 chapters in the United States and abroad, the association promotes, develops and protects the practice of social work and social workers. Virginia Chapter represents more than 3,200 professional social workers.

NASW-Virginia is looking for recommendations for our 2012 Annual Conference Awards Ceremony. Categories include BSW, MSW, Lifetime Achievement, and Social Worker of the Year. If you know someone deserving of this recognition please e-mail our Marketing and Membership Services Coordinator, Cara Crowley at caracrowley@naswva.com.

nasW-Virginia 2011 annual awards nomination form please complete and return this form by fax (804) 204.1539 or mail by friday, february 10, 2012. remember, nominees must be current members in good standing with nasW-Virginia chapter. please print legibly or type. The following individual is being nominated for: _____ 2012 BSW Social Work Student of the Year _____ 2012 MSW Social Work Student of the Year Award _____ 2012 Social Work Lifetime Achievement Award _____ 2012 Social Worker of the Year

Nominee name: _________________________________________________________________________________ Nominee Phone: (work) _____________________________ (home) _____________________________________ Nominee Current Position: ________________________________________________________________________ Nominee Business Address: _______________________________________________________________________ (continued on next page) NASW VIRGINIA CHAPTER neWs 22


Nominator: _____________________________________________________________________________________ Nominator Work Address: ________________________________________________________________________ Nominator’s Signature: ___________________________________________________________________________ Nominator’s Phone: (work) _________________________________ (home) ________________________________

Please explain why you are nominating this individual: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ ________________________________________________________________________________________________

please use additional pages, if necessary Mail to: nasW-Va awards 5511 staples Mill rd., ste 303, richmond, Va 23228 phone: (804) 204.1339 e-mail: caracrowley@naswva.com

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Virginia Chapter

National Association of Social Workers Virginia Chapter 5511 Staples Mill Road, Suite 303 Richmond, VA 23228 804-204-1339

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2012 annual conference

N AS W VIRGINIA CHAPTER Preconference Leadership Institute: Thursday March, 8, 2012 Annual Conference: Friday and Saturday, March 9-10, 2012 Hilton Short Pump Hotel & Spa Look for more information coming soon. Interested in presenting? Look at call for papers application and info on pages 4-8 inside this edition.

November Decmember 2011 Newsletter  

Member's Only- November/December Newsletter

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