America is faced with many persistent issues, many of which are due to the growing divide between our two leading parties. One issue that profoundly stands out is income inequality and poverty. Income is a major determinant of health and well-being. Some of the most significant aspects of an individual’s life are determined by income level or socioeconomic status. Income plays a significant role in education and employment opportunities, and most notably housing status. Outside of occupational disparities those with a lower income status are also subject to more health concerns, a trend that has worsened in recent years due to the COVID 19 pandemic. According to the National library of Public Medicine, data from Medicare revealed that older adults with a low income are more likely to be diagnosed and hospitalized with COVID 19.  
The COVID 19 pandemic was followed by more concerning trends past the pandemic’s initial stages. According to the National Library of Public Medicine, the wealthy fared well during the pandemic and by august of 2021, estimates suggest that the collective wealth of U.S billionaires increased by over a trillion dollars. Meanwhile, millions still live at or below the poverty line. Data from the U.S census bureau revealed that 37 million people lived in poverty, 15 million of which are children. Considering the impact income has on health and longevity, this is a concerning figure affecting predominantly marginalized communities. For decades, we have seen the effects wealth disparity has on health factors, yet this problem persists. The National Library of Public Medicine found that today 50% of household income goes to the top 10% of income earners in America, while only 13 % of household income goes to the bottom 50% of income earners. This dispairty also coincides with survival rate, as income determines the quality of housing, education, and healthcare. Without the ability to afford necessities, low-income individuals are subject to a more hazardous lifestyle meaning that health factors as well as crime and violence are more likely to occur for those affected by the wealth disparity.  
For long before the start of the COVID 19 pandemic, wealth inequality was a major problem that created more disparities for those affected. For decades we have seen the impacts this issue has on health and well-being. Like many Americans one can only hope our government intervenes and, at the very least, reduces the severe impacts that arise from wealth inequality.  ​

Since the beginning of the 21st century accessing mental health care has been needlessly difficult, particularly for marginalized communities. Many providers have limited what kind of insurance they will accept, putting people in need in a disadvantageous position forcing them to pay out of pocket for treatment. The COVID 19 pandemic further highlighted the various barriers to accessing mental health care and historically marginalized communities experienced the greatest barriers to accessing health care. According to a study conducted by the National Library of Public Medicine, the odds of having health insurance were 40 % lower for people with serious psychological distress than for those without. This is particularly concerning when considering the cost of treatment. According to a study by the American Center for Progress the average cost of a psychiatric diagnostic evaluation in Minnesota is $241 and the total cost for 12 sessions of psychotherapy is $1,920. Considering the broad scope of mental illnesses in contemporary society, psychotherapy providers could recommend more intensive treatment leading to a higher cost for clients in need who are paying out of pocket. This is where we see a clash between insurers and care providers. In some states, insurance companies have the authority to deem what is and what is not a medical necessity. The main problem that arises with this is that it limits the level of autonomy for those attempting to access mental health resources. The interference from insurance companies makes it difficult for care providers to ethically carry out their duties. The term “medical necessity” is also ambiguous and hard to define and clinicians who often deal with insurance companies believe that it is a way for insurance companies to undermine the client’s autonomy and access to treatment. For far too long insurance companies have made accessing necessary care needlessly difficult and it is apparent that having insurance companies active in the process only hinders the progress of those seeking care.  
References 
Director, S. Nadeau                    Associate, Nadeau, S., Director, A., President, J. Cusick                    Vice, Cusick, J., President, V., Director, M. Shepherd                    Senior, Shepherd, M., Director, S., Rapfogel, N., Altiraifi, A., Sozan, M., Correa-Buntley, T., Ombres, D., Ballard, D., & Bedekovics, G. (2020, March 23). The Behavioral Health Care Affordability Problem. Center for American Progress. https://www.americanprogress.org/article/the-behavioral-health-care-affordability-problem/ 
Rowan, K., McAlpine, D. D., & Blewett, L. A. (2013). Access and cost barriers to mental health care, by insurance status, 1999-2010. Health affairs (Project Hope), 32(10), 1723–1730. https://doi.org/10.1377/hlthaff.2013.0133 
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Religion is often looked upon as an uplifting source of support and personal growth. Religion and spirituality can provide a sense of belonging for individuals, families and communities and provides a sense of meaning to those who practice. According to the Pew Research Center a majority of the world’s population reports being spiritual or belonging to a religious sect. Religion and spirituality is often seen as a source of resilience and coping, when individuals, families, and communities experience hardship it is customary practice across the world to turn to religion as a source of hope. There is still much debate over among experts and religious leaders regarding how exactly to define religion and spirituality, which makes defining religious trauma and religious trauma syndrome (RTS) difficult. Since this is a rather new phenomenon being discussed among respective fields of social science, the definition of religious trauma remains ambiguous. Initial research around religion and spirituality focused predominantly on coping and resilience among other mental health benefits. Recent research has gone in the other direction and has explored ways religion and religious groups may lead to and amplify health concerns.  
One of the definitions of religious abuse provided by the American Psychological Association is “mistreatment of a person who is in need of help, support, or greater spiritual empowerment, with the result of weakening, undermining, or decreasing that person’s empowerment.” This definition alludes to a person’s vulnerability and/or autonomy and brings attention to the needs of the people who indulge in religious or spiritual practice. Religious abuse also results from religious leaders taking advantage of their spiritual position by narcissistically reminding followers of their power, eventually leading to fear and paranoia among community members. The American Psychological Association presents several effects that religious trauma can have on victims including distorting the image of God or a higher power, creating barriers to setting healthy boundaries, as well as barriers to forming trusting and compassionate relationships in the future. The effects can also lead to hermeneutical injustice, which occurs when the victim’s harm results from a lack of knowledge which prevents them from acting in accordance with their own values. These effects can lead to severe cycles where, in many cases, victims suffer from cognitive dissonance and are unable to recognize, or simply refuse to acknowledge, the faults in their leaders and abusers.  
The recent discourse surrounding religious/spiritual abuse has brought attention to the aspect of cultural competence and cultural humility. Cultural competence relies more heavily on knowledge of distinct cultures, while cultural humility relies on knowledge but also emphasizes the need for critical self-reflection. Religious/spiritual trauma is not universal, not everyone suffers from abuse, and it is the duty of social workers to display humility when working with someone who has endured religious or spiritual abuse. According to the Industrial Psychiatry Journal, RTS was first termed by American Psychologist Marlene Winell. One area of study that has influenced has healthcare providers treat RTS is the amount of research on trauma or traumatology in the last 20 years. Research in traumatology has shown that people react differently, and this could be because of personal or any contextual factors. When victims who have experienced RTS are re-introduced to certain factors or triggers, their nervous systems can be mistakenly aroused and often the victim re-experiences the event. Dr. Marlene Winell outlined 3 stages of RTS which are as follows: 1) Pre-deconversion Trauma- harm done by religious beliefs and practices during the time a person is religious, 2) Deconversion- Acute period of leaving a religion, 3) post-deconversion adaptation- long-term mental health issues, delayed development, and cultural adjustment in the “world.” Treating RTS requires a holistic approach and an understanding of every aspect of the individual.  
 
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In recent years, specifically from the presidential elections in 2016 to the midterm elections in 2022, there has been an increase in young voter participation in  
America. Young voter participation has been typically lower when compared to the rest of the general population in America. While there have been noticeable fluctuations in the 21st century, the most recent trend showed a nine percent increase from 39.4% of youth voter turnout in 2016 to 48% in the 2020 presidential election. The current trend is showing progress but there are still several structural and intentional barriers young voters must face each election in order to cast their ballot. The barrier that stands out most is the targeted efforts to disenfranchise and discourage young voters from engaging in the political process. Most of the efforts to disenfranchise young voters are consolidated in residency laws, which affect college students, specifically out-of-state students. Residency laws require students to either return home or, in some states, acquire a new driver's license and establish legal residency in a new state. This puts college students in a difficult position as they must choose between making arrangements to return home or going through the whole registration process in a new state.  
Young people face structural barriers to voting outside of the intentional barriers put in place by politicians. On average, young people often move far more often compared to the general population and this is not strictly indicative of young voters in college. Socioeconomic barriers limit the amount of employment opportunities that young people have. This leads to young people working jobs with less predictable schedules and their schedules can often affect their ability to even find the time to vote. Out of all eligible voters in America approximately 40 million of them are classified as Gen z voters. Those aged 18-29 years old constitute nearly 22% of the total American voting age population but in 2018 they made up only 13% of the electorate. The structural and intentional barriers restrict an enormous faction of our society from participating in the democratic process. The population of young voters are currently the most diverse generation of voters and while there has been an increase in young voter participation in recent years, there are still inconsistencies in how each state hinders or engages young voters in the political process. 
References  
Brill, L. (2024, January 19). A Silenced Generation: How the Power of the Youth Vote Collides With Barriers to Voting . Mapresearch.org. 
Tor, E. (2020, February 20). Why so many young people don’t vote – and how to change that. Frank Batten School of Leadership and Public Policy | University of Virginia. https://batten.virginia.edu/about/news/why-so-many-young-people-dont-vote-and-how-change 
Beadle, K., de Guzman, P., & Medina, A. (2022, March 17). The impact of voting laws on youth turnout and registration. Circle at Tufts. https://circle.tufts.edu/latest-research/impact-voting-laws-youth-turnout-and-registration 
 
 
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As we move into the 2024 election season it is important to prepare for the aftermath of the election. Regardless of the outcome, there is potential for civil unrest. Action Link (a LGBTQ organization that focuses on policy and advocacy work) has developed a plan in the event of civil unrest. Plan ahead as we move into November and know that social workers are here to help advocate for those in need. 
Preparing for Potential Civil Unrest During an Election Cycle
Stay Informed

• Monitor the news. Follow reliable news sources to track developments.
  
• Sign up for local alerts. Utilize any community alert systems and emergency apps such as FEMA, CodeRED, or city-specific services.
  
• Monitor social media. It is helpful to follow local law enforcement and community organizations for real-time updates, but be cautious about the potential for misinformation to be spread.
  

Create Your Safety Plan

• Identify safe zones. Know where the locations are for police stations, hospitals, and LGBTQ+ community centers in your area.
  
• Plan evacuation routes.  Prepare multiple routes to leave your home or city if necessary.
  
• Stay home if possible. Avoid crowds, protests, and large gatherings where tensions may escalate.
  
• Create a family and friends communication plan. Agree on how you will contact each other in an emergency and where to meet if separated.
  

Stock Up on Essentials

• Food and water. Store at least 72 hours' worth of non-perishable food and one gallon of water per person in your household per day.
  
• First aid kit. Include basic medical supplies and any personal medications.
  
• Get cash. Have cash on hand in case ATMs or digital payment services are disrupted.
  
• Fuel up. Keep your car’s gas tank full.
  
• Supplies. In case of power outages, have flashlights, batteries, portable chargers, and radios ready to go.
  

Ensure Your Home is Secure

• Doors and windows. Ensure your home is locked and consider reinforcing entry points if tensions are high.
  
• Outdoor lighting. Use motion-activated lights to deter trespassers.
  
• Neighborhood coordination. Stay in touch with trusted neighbors to monitor unusual activity.
  
• Emergency equipment. Fire extinguishers, basic tools, gas shut off tool, and protective gear (masks, goggles, gloves).
  

Self-Defense Awareness

• Non-lethal options. Consider pepper spray or personal alarms for protection.
  
• Training. Take basic self-defense classes to feel more prepared.
  
• Avoid violence. Engage in de-escalation strategies whenever possible to reduce confrontation.
  

Mental and Emotional Preparedness

• Manage stress. Practice self-care and mindfulness to remain calm.
  
• Friends and family reassurance: Prepare children and other dependents with simple explanations and instructions to reduce anxiety.
  
• Support network. Maintain connections with family, friends, or mental health resources to help cope with uncertainty.
  

Engage with Your Community

• Local organizations: Know what local civil groups or community programs offer support during unrest. Find your local LGBTQ+ community center here.
  
• Help neighbors in need. When it is safe, check on elderly or vulnerable neighbors and offer help.
  

Legal Awareness

• Know your rights. Be informed about the laws related to curfews, protests, and emergency declarations.
  
• Document encounters. If you witness unrest, record interactions if safe to do so.
  

Contingency Planning for Employment or Travel

• Remote work. If possible, arrange to work remotely if your workplace is near volatile areas.
  
• Cancel unnecessary travel: Avoid travel if possible, especially to areas prone to unrest.
  
• Supply chain issues. Be aware of possible disruptions in deliveries or public services.
  

For more information visit: ​https://www.lgbtactionlink.org/

In November there are two amendments on the Kentucky Ballot. Here is a little information on those amendments: 

• Constitutional Amendment 1: this amendment is intended to add another measure that will prevent non-citizens in the state of Kentucky from voting in local, state, and federal elections. Here is what the actual amendment is in short: “No person who is not a citizen of the United States shall be allowed to vote in this state.” Here is how this amendment will appear on the ballot:  
  

• Are you in favor of amending Sections 145 and 155 of the Constitution of Kentucky to prohibit persons who are not citizens of the United States from being allowed to vote in the Commonwealth of Kentucky, as stated below? 
  

• Every citizen of the United States of the age of eighteen years who has resided in the state one year, and in the county six months, and the precinct in which he or she offers to vote sixty days next preceding the election, shall be a voter in said precinct and not elsewhere. No person who is not a citizen of the United States shall be allowed to vote in this state. The following persons also shall not have the right to vote: 
  

• Persons convicted in any court of competent jurisdiction of treason, or felony, or bribery in an election, or of such high misdemeanor as the General Assembly may declare shall operate as an exclusion from the right of suffrage, but persons hereby excluded may be restored to their civil rights by executive pardon. 
  

• Persons who, at the time of the election, are in confinement under the judgment of a court for some penal offense. 
  

• Idiots and insane persons. 
  

• In simple terms this is a completely unnecessary act that aims to ban something that is already illegal in all 50 states. This aims to add to a document that is needlessly long, and, in several sections, the language is outdated and does not reflect the state’s current values. The original version limited voting rights only to white males aged 21 and over and while this amendment does not aim to take us back in time it aims to needlessly add to an already long document. According to the courier journal studies have shown that it is extremely rare for non-citizens and undocumented immigrants to vote in local, state, and federal elections. According to the Boone County, Ky Republican party page, there have been no reported cases of non-citizens voting in Kentucky elections. Even supporters of this proposed amendment are aware of the absence of this issue, yet still it is being pushed to a vote. Those who oppose this proposal see it simply as a tactic to energize the republican base during an election year. This proposal really does nothing to improve the state’s constitution and is a pointless ploy aimed at dividing the citizens of Kentucky.  
  

• Constitutional amendment 2: this amendment is aimed at allocating public funds for private schools so that private schools can operate the same manner as public schools. This proposed amendment aims to provide equal education opportunities for all students and families across the state of Kentucky by using public funds to preserve private schools. Here is what the proposed amendment will look like on the voter’s ballot:  
  

• To give parents choices in educational opportunities for their children, are you in favor of enabling the General Assembly to provide financial support for the education costs of students in kindergarten through 12th grade who are outside the system of common (public) schools by amending the Constitution of Kentucky as stated below? 
  

• This proposed amendment is aimed to provide public funding for private schools. Public schools are already low on funding in many areas of the state, and this would further reduce the limited access to the necessary resources they desperately need. One example that stands out to me is the Jefferson County School system (JCPS). For several consecutive years in a row now, the busing system has been severely under-staffed and in the first few weeks of school this year some districts were unable to get their students home before 6:00 pm. JCPS is one of the largest school systems in the state and they would suffer severe consequences with the passing of this amendment. Much of the public funds for schools around the state are allocated to providing free meals for kids with lower SES. Reducing the funds available for public schools limits access to several necessary resources for kids who have a challenging time accessing them. Supporters of this bill want to emphasize equal education opportunities for all students, but allocating public funds, which public schools rely on for their own students, to private schools will only worsen the conditions of many struggling public school systems across the state.  
  

 
References 
 
Horsley, McKenna. (2024) Amendment 1: ‘Proactive’ or a ploy to stir up anti-immigrant vote? 
https://kentuckylantern.com/2024/10/10/amendment-1-proactive-or-ploy-to-stir-up- anti-immigrant-vote-boost-the-other-amendment/ 
Adams, M. G. (2024). 2024 constitutional amendments. An Official Website of the Commonwealth of Kentucky. https://www.sos.ky.gov/elections/Pages/2024-Constitutional-Amendments.aspx 
Collins, Emma. (2024). Kentucky’s Proposed Amendment 2: Bad for Taxpayers, Bad for Kentucky. https://www.kentuckylawjournal.org/blog/kentuckys-proposed-amendment-2-bad-for-students-bad-for-taxpayers-bad-for-kentucky 
Pinski, H. (2024, October 9). Kentucky ballot measures. Courier Journal. https://www.courier-journal.com/story/news/politics/elections/2024/09/13/kentucky-ballot-measures/74231405007/ 
Vanderhoff, M. (2024, September 16). Get the facts: New ad campaign urges Kentucky voters to approve Amendment 1. WLKY. https://www.wlky.com/article/ad-campaign-kentucky-voters-approve-amendment-1/62177936 
 
 
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As we approach the upcoming 2024 presidential election the significance of voting cannot be understated. In recent elections, specifically from 2008 to 2020, voter participation has noticeably fluctuated. Presidential election turnout rates dropped about four percent between the 2008 and 2012 elections. There was a much larger fluctuation found in the mid-term election turnout from 36.7 percent in 2014 to 49.7 percent in 2018 following the controversial election of Donald Trump according to the Journal of Social Work education. The inconsistency in voter turnout rates among eligible voters is considered problematic among experts as a strong democracy is hindered by low participation of voters. Voting allows individuals, families, organizations, and communities to voice concern or disapproval for certain policies. Voting also allows vulnerable populations to a chance to engage in the political process and can be a powerful tool for change for marginalized communities.  
Scores of empirical evidence have linked voting and health. One study conducted by the National Library of Public Medicine (NLPM) sought to examine the relationship between differences in voter participation and the impact on public health. According to this study by the National Library of Public Medicine, four interrelated areas were discovered in association with voting. The first is that there is a consistency in the association between voting and health, the second is differences in voter participation are associated with health conditions, the third is gaps in voter participation may be associated with electoral outcomes and the fourth is interventions in healthcare organizations can increase voter participation. The results of this study revealed that voting and health are associated, but more importantly people with much worse health are less likely to engage in the political process. Health is, and has been, significantly impacted by social factors and processes, commonly known as the social determinants of health. According to the National Library of Public Medicine the social determinants of health are shaped by the distribution of power and resources. Voting also significantly impacts the distribution of power and resources as larger voter participation translates into greater influence over determining who holds political power and can enact change in a given community.   
As social workers we often find ourselves at the intersection of advocacy and empathy in our commitment to justice. Arguably more than any other profession, social workers experience firsthand societal inequities, systemic oppression, and often witness policies fail marginalized communities. The clients social workers serve often lack a strong political voice and the distribution of power and resources works against these communities. Those who hold political power tend to reward those who engage in the voting process by putting forward support policies that respond to the demands of their respective communities. Policies enacted by elected officials typically shape the social determinants of health. With that in mind voter participation has also been strongly associated with socioeconomic status as well. Research has shown that those in lower income communities and those with a lower level of education are associated with lower rates of voter participation during elections. This connection also pertains to people with physical, intellectual, and psychological disabilities revealing they too consistently have lower rates of voter participation. According to the study conducted by NLPM, results unveil that lower voting rates were associated with poor self-rated health measured by health risk behaviors, mortality, chronic health conditions, and hospitalization. The findings also reveal that voting is positively associated with self-rated health regardless of Socio-economic status.  
The discourse around voting for social workers has been a controversial topic. There are some in the field who accept prevailing myths about voter mobilization while on the job being partisan considering it unethical, with some even going as far as to say it is illegal according to the Journal of Social Work Education. On the contrary, voting is an extension of a Social Workers professional ethics and encouraging clients to register can be a powerful tool for change, especially for vulnerable populations. At the most basic level, Social Workers should lead by example, and by not engaging in the political process is unethical and not conducive to fostering change and empowerment.  
References 
Abramovitz, M., Sherraden, M., Hill, K., Smith, T. R., Lewis, B., & Mizrahi, T. (2019). Voting is Social Work: Voices From the National Social Work Voter Mobilization Campaign. Journal of Social Work Education, 55(4), 626–644. https://doi.org/10.1080/10437797.2019.1656690 
Brown CL, Raza D, Pinto AD. Voting, health and interventions in healthcare settings: a scoping review. Public Health Rev. 2020 Jul 1;41:16. doi: 10.1186/s40985-020-00133-6. PMID: 32626605; PMCID: PMC7329475. ​

Mental health has long been overlooked as a crucial factor in overall health and well-being. However, recently mental health has recently taken center stage in public health discussions across the nation. Like every state, the state of Kentucky faces a unique set of challenges regarding mental health and mental illness ranging from substance abuse problems to suicide to depression & anxiety. Of the major concerns that arise with these varying mental health concerns, one that is often ignored is the victims’ access to the appropriate healthcare. Most Americans, approximately 164 million have insurance plans via their employers. Despite that, in many states including Kentucky, insurers can set their own standards regarding what they deem as a medical necessity. Often instances occur where an insurance company interposes itself between the mental healthcare provider and the client sometimes threatening the provider’s job security, often assaulting their dignity, as well as sifting through case notes with sensitive details. Social workers, healthcare providers, therapists, psychologists, etc., commonly deal with these ethical dilemmas which often leaves them in a situation where they wish to act morally but cannot given the constraints of their predicament. In some instances, this leads to our most vulnerable communities being denied access to proper health care due to the insurance companies interfering with the process. 
In recent years Kentucky has made several critical legislative moves to address the mental health challenges our state is facing. Our state wants to make mental health care more affordable and accessible to ensure individuals receive the care that they need. One of the most significant changes in mental health law in our state was Tim’s Law in 2017, which allows for court-ordered outpatient treatment for individuals who have been involuntarily hospitalized multiple times. The law is aimed at preventing a vicious cycle of hospitalization and release by ensuring those with severe mental illness remain in treatment. So instead of cycling through the system of state hospitals, or in many cases jails, Tim’s law gets people with the most severe mental illness into outpatient treatment. Tim's law has become a valuable tool is assessing the need for treatment in unique cases of mental illness. Recently, in June of 2022, Govenor Andy Beshear signed for two bills aimed at helping more individuals across the state access mental health services. The first bill, House Bill 127, expands access to assisted treatment. This bill allows the courts to order outpatient care for individuals with serious mental illnesses. This method is intended to ensure that every individual with a severe mental illness is guaranteed the treatment they need even if they do not have the means to access treatment on their own. Second the Govenor signed house bill 562 aimed getting first responders across the state access to the mental health care they need. The bill has sanctions allowing for peace officers, firefighters, EMS workers, and any other first responder to take 48 hours leave after being involved in a criminal incident. The incidents could refer to anything from a car accident to the death of a colleague. Each of these bills, House Bill 127 in particular, is aimed at expanding Tim’s law (2017) by allowing for greater access to those who would benefit from outpatient treatment by modifying the criteria for medical necessity. House Bill 127 also requires more thorough evaluation of individuals who may receive court-ordered treatment. Another way this Bill expands on Tim’s law is by helping to cover additional treatment costs necessary to ensure successful re-entry into the community. Our state has made big strides in making mental health care affordable and accessible to those who need it most.  
There are still more laws that need to be passed to reduce interference from insurers regarding those who still experience barriers to accessing treatment. In many states, including Kentucky, insurers are often able to set their own standards for defining when mental health services are medically necessary. This is alarming considering our state does not have any laws or sanctions that regulate how insurers conduct reviews of behavioral healthcare. This subjects both clients, and those in need of treatment, to the judgement of an insurer and prevents providers from being able to act morally given the constraints of their predicament. There is no guideline in the NASW’s code of ethics that specifies for providers how to balance the disparity of profit-motives and service to vulnerable populations and creates a persistent ethical challenge that many healthcare providers as well as policy makers must navigate. The federal Mental Health Parity and Addiction Equity Act of 2008 banned some of the harsher restrictions insurers had for those seeking treatment for mental health. However, since the passing of this act insurers have turned to utilization reviews, in which they can request progress notes from the providers which are full of sensitive details and as part of their assessment process. Healthcare providers have found that these reviews are only used as a means to dispute the necessity of further treatment. 
References  
Team Kentucky (2022). Gov. Andy Beshear Signs Two Bills Supporting Mental Health Access 
https://www.kentucky.gov/Pages/Activity-stream.aspx?n=GovernorBeshear&prId=1381#:~:text=Since%202017%2C%20Kentucky%2C%20along%20with,it%20out%20on%20their%20own. 
NASW. (2021) Code of Ethics of the National Association of Social Workers  
https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English 
Annie Waldman and Maya Miller (2024, August 27) What Mental Health Care Protections Exist in Your State? 
https://www.propublica.org/article/mental-health-wiltn-states 
Centers for Medicare and Medicaid Services. (2024). The Mental Health Parity and Addiction Equity act (MHPAEA). 
https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity 

Submitted by William King, BSW Practicum Student, University of Kentucky
 
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Updates regarding the Social Work Compact:
The Department of Health and Human Services, through the Health Resources and Services Administration (HRSA), announced the first-ever Licensure Portability Grant Program, which is an investment in a multi-state social worker licensure compact. This grant will provide $2.5 million in support of the Social Work Compact. This welcome support will make the implementation of the Compact easier and less of a financial burden for LCSWs who live in states that have passed the Compact and choose to join as individuals. Please visit the U.S. Department of Health and Human Services website for more information.
More details about the Compact will be forthcoming after the September 17 meeting to establish the Commission that will be running the Compact, which I will be running as Interim Chair. CSWA will continue to provide information about the Compact as it develops.

What does this mean for social workers? This could provide more options for our clients, for work opportunities, and for the growth of mental health care throughout the United States. Stay up to date with all the current news with KSCSW.

Change is a universal human experience and with it comes a multitude of experiences, emotions, and challenges. There are critical junctures in life, often referred to as life transitions, that bring about a significant amount of change for an individual due to quickly and vastly evolving circumstances. Some people find that they move through these transitions relatively easily, while others may require more support in adapting to the changes that may come. This article explores the concept of life transitions and how counseling for life transitions can help clients to build resilience and find positive personal growth during such periods of transformation.
WHAT ARE LIFE TRANSITIONS?
The term life transition refers to a significant change in an individual’s personal, professional, or social life requiring one to adapt to new circumstances, responsibilities, or roles than previously held. Life transitions are often marked by important events but they can also occur as a result of unmet expectations for one’s life.
Types of Life Transitions
Anticipated life transitions are changes that you expected to happen. Because anticipated life transitions may allow for some level of predictability, an individual might experience a greater sense of control than for other types of life transitions. Examples of anticipated life transitions include graduating from high school, having a child, or entering into retirement. 
Unanticipated life transitions are changes in life that occur without notice and without the ability to plan. Unanticipated life transitions might include experiences such as the death of a close family member, an unexpected medical diagnosis, or the loss of a job.
Non-event life transitions are changes we expected to occur in life but do not. Non-event life transitions stem from unmet expectations an individual might have for their life, for example, not having children when one expected to or not being able to retire at the anticipated age due to financial difficulties.
Examples of Common Life Transitions
Among many others, the following are some common types of life transitions that people might seek a counselor for:

• Developmental transitions – change that occurs at milestone ages such as entering into adulthood at 18 or entering into retirement age
• Relational transitions – adjusting to a change in relationship status such as navigating a divorce, entering into marriage, or losing a loved one
• Career transitions – marked by a change in job status such as retiring or being promoted from a current position
• Health transitions – navigating a medical diagnosis or change in health status such as adjusting to life with a chronic illness or experiencing a major injury that impacts one’s lifestyle
• Identity transitions – adjusting to changes in culture such as during a significant move or getting involved in a new community

HOW DO LIFE TRANSITIONS AFFECT INDIVIDUALS AND HOW CAN COUNSELING HELP?
Any considerable transition comes with acute stressors that may affect an individual’s mental health. The overarching goal of counseling for life transitions is to support the client in processing the change and navigating its effects in a way that is meaningful to them. Because people react differently to stress, there is no one size fits all method to counseling but sessions may often focus on building resilience and confidence while learning how to manage stress and its many effects on health and lifestyle for a better experience of the life transition. A counselor’s role in supporting positive coping mechanisms is important and ever-evolving. For those interested in advancing their knowledge of how to support such clients, the Kentucky Society for Clinical Social Work provides helpful continuing education trainings and events to help clinicians further their skills and education.
Effective Strategies in Counseling for Life Transitions
The following are common techniques used in counseling for life transitions to specifically target the challenging experience of and emotions surrounding major change:

• Resilience training

In order to increase adaptiveness and manage resistance, which is often a natural response to change, counselors can engage clients in techniques that promote resilience such as goal setting, reframing of unhelpful thoughts, practicing acceptance, and the development of problem-solving skills.

• Emotional support through active listening

It is widely believed that one of the most effective tools of counseling is the therapeutic relationship itself. Creating an environment of trust and support through active listening can help the client break through resistance, process difficult emotions, and find easier direction in goal setting during transitional times.

• Mindfulness practice

Practicing mindfulness during challenging times can bring greater clarity and rationality while processing difficult emotions. Mindfulness brings us into deeper awareness of our bodies, helps us use curiosity to explore different feelings as they come up, and supports the maintenance of healthy routines which all allow for more effective processing of the experience of change and the emotions that may come with it. The Kentucky Society for Clinical Social Work has an excellent database of mindfulness resources that can be downloaded and used with clients.

• Identifying and building support networks

Helping clients to foster connections with others who understand their circumstances or who clients can turn to during difficult times is an important tool for building and maintaining resilience. Supporting clients in prioritizing relationships helps to decrease isolation, which can be a common response to experiencing challenging times, and encourages opportunities for positive emotional connection.

• Self-reflection and personal growth learning

Change can be good but there is a mindset shift that must occur in order for an individual to find growth in the midst of a difficult transition. An important role of the counselor is to support clients in reflecting on both past and present experiences and how the changes they have experienced throughout life have shaped who they are and who they would like to become.

• Goal setting

Major life transitions are often difficult to process because they can leave a person feeling directionless. Where one may previously have found purpose in their routines, responsibilities, or roles, the changes that have occurred may result in a sense of loss. Clinicians can help clients gain clarity in their goals for the future and find direction during a time of cloudy vision by breaking down values, establishing important objectives they may have for the future, and identifying steps toward achieving these goals.

• Cognitive-behavioral techniques

Counselors can help clients manage transition-induced stress, anxiety, and other difficult emotional states by teaching and practicing coping skills that combat the negative mindset often perpetuating such feelings. Among other interventions, useful techniques may include cognitive restructuring, relaxation exercises, skills training, and successive approximation.
CONCLUSION
There are a number of therapeutic frameworks and techniques that are helpful in treating clients moving through periods of significant change. Because change is an inevitable part of life, it is important for clinicians to understand how to support clients through major life transitions in meaningful and beneficial ways.
Among other resources, the Kentucky Society for Clinical Social Work hosts peer supervision and support for clinicians through a monthly group, where counselors may seek advice for treating clients through major life transitions.

--Peyton Fisher, MSW




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