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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​A 2023 Gender and Politics study by PRRI found that half of Americans feel strongly that there are only two genders. Science, and the diverse experiences of intersex individuals, tells us otherwise. Experts estimate that up to 1.7 percent of people are born with intersex traits, meaning their biological sex does not neatly fit into typical definitions of either male or female.
While we generally think of female as a genetic “XX” and male as “XY,” there are many variations in chromosomal combinations, hormonal patterns, reproductive organs, and anatomy. So far, medical professionals have identified over 40 intersex variations, with more being discovered as science advances.
For many years, the medical community has defaulted to involuntary “corrective” surgeries for intersex infants and children, conducting non-lifesaving procedures to change natural variations in genital appearance or reproductive anatomy. The United Nations Office of the High Commissioner for Human Rights supports bans on these types of surgeries.
According to the Trevor Project, mental health challenges among intersex youth are disproportionately high compared to LGBTQ youth who are not intersex. interACT, an advocacy organization for intersex youth, has a great resource for therapists that underscores the person-centered and strengths-based approaches that are integral to social work, while providing additional context on lived experiences.
For more context on individual experiences, the documentary Every Body (2023) tells the stories of three intersex individuals and discusses the harmful physical and mental effects of these surgeries. Additionally, intersex activist Pidgeon Pagonis published a memoir last year, Nobody Needs to Know.
It's important for social workers to understand this context as we advocate for the dignity and worth of each person, and their right to self- determination. Whether we are working with clients with intersex traits, or with parents as they navigate caring for a child who is intersex, we need to be aware that individuals who are intersex face unique challenges.

Medicare Physician Fee Schedule Final Rule Summary: CY 2024

The final rule for the Medicare Physician Fee Schedule (PFS) in 2024 has been issued and will go into effect on January 1, 2024. This link is to the complete Summary: https://www.cms.gov/files/document/mm13452-medicare-physician-fee-schedule-final-rule-summary-cy-2024.pdf
Please find a list of the changes that will affect clinical social workers below.
Physician Fee Schedule Changes
New codes:

• CPT 0591T-0593T will now be available for “health and well-being coaching services” on a temporary basis.
• HCPCS G0136 will now be available for Social Determinants of Health Risk Assessment (SDOH) permanently.

Telemental Health Services:

• Telemental health services will continue to be covered through 2024, regardless of where the patient is located.
• The requirement that patients be seen in person every six months is delayed throughout 2024.
• The modifier for telemental health services will continue to be “95”.

Expansion of Behavioral Health Services:

• LMFTs and LMHCs will be included as mental health providers under Medicare.

Expansion of Crisis Codes:

• CPT codes for crisis services, 90839 and 90840, will be covered by Medicare regardless of the location of the patient.

New Codes for LCSWs:

• Health Behavior Assessment and Intervention (HBAI) services will now be covered for LCSWs by Medicare using CPT codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168. These codes are designed to assess the psychological, behavioral, emotional, cognitive, and social factors included in the treatment of physical health problems.

Change to Relative Value Units (RVUs) for LCSWs:

• Over the next four years there will be an increase in payment for in-office psychotherapy, to be determined.

Clinical Social Work Association
The National Voice of Clinical Social Work

On June 29th, the US Supreme Court declared in Students for Fair Admissions inc. v. President and Fellows of Harvard College that race-conscious admissions programs at Harvard and the University of North Carolina violate the Constitution’s guarantee of equal protection. Affirmative action is a policy that has long aimed to address historical discrimination and promote diversity in the United States. Discussions about its implications for education, employment, and society as a whole have ensued based on the Supreme Court's most recent decision.

What are the potential consequences to this ruling?
1. Reduced Diversity:
One immediate concern following the end of Affirmative Action is the potential decline in diversity within educational institutions and workplaces. Affirmative action strived to create equal opportunities for underrepresented groups, ensuring a more inclusive environment. With its elimination, there's a possibility that minority representation may decrease, affecting perspectives, experiences, and social interactions within these spaces.

2. Widening Achievement Gaps:
Affirmative Action sought to bridge the achievement gaps faced by marginalized communities by providing additional opportunities. Without this policy, disadvantaged individuals may face increased barriers when competing for higher education or job opportunities. This could potentially reinforce existing disparities and hinder progress in closing achievement gaps.

3. Social and Economic Impact:
The end of affirmative action has the potential to perpetuate socioeconomic inequalities. Historically marginalized groups may face difficulties in accessing quality education and securing well-paying jobs, ultimately impacting their upward mobility and economic status. This shift could undermine efforts to achieve social justice and equality.

What does this mean for social workers?
The US Supreme Court's decision to end affirmative action can potentially have an impact on social workers. Affirmative Action policies were put in place to address historical disadvantages faced by certain groups in society, and this included providing equal
opportunities in employment and education. With the removal of such policies, social workers may need to adapt their approaches to address these disparities in a different way. They may need to actively work towards promoting diversity and equal opportunities
within their practice, ensuring that individuals of all backgrounds have access to the support and resources they need. It is also important for social workers to stay updated on any new laws or regulations that emerge in response to this decision, as this could impact the way they navigate issues related to discrimination and inequality in their work. What other consequences arise from this decision? How can social workers find new ways to promote equal opportunity? Comment below.

By Laura Groshong, LICSW, Director, Policy and Practice
Here are two issues which I hope you will all address with your members of Congress and your state legislature.
For Members of Congress:

• H.R. 2474 is a bill which would improve Medicare reimbursement rates by using the rate of inflation as the way to adjust reimbursement each year instead of the Physician Fee Schedule (PFS) which does not use inflation as a factor. 
• H.R. 2474 would also tie reimbursement to the Medicare Economic Index which is based on provider expenses and other economic trends.
• Medicare rates have not increased since 2001, making payments 26% lower today than they were then, when adjusting for inflation. This is one of the major reasons that LCSWs are opting out as Medicare providers. There is a freeze on updated reimbursement until 2026.
• Though this is a House bill, please let your Senators know as well.  You can contact them all at https://www.congress.gov/contact-us .  Here is a message you can use or change it to use your own words: “I am a Licensed Clinical Social Worker and a constituent. Please support H.R. 2474 which will make Medicare reimbursement more equitable for mental health services. Reimbursement rates have not increased since 2001 and are therefore 26% less when adjusted for inflation. LCSWs are opting out as Medicare providers, leaving vulnerable beneficiaries without adequate mental health services. Thank you for your support.”

For State Legislatures:

• The Social Work Compact is now available to be passed by state legislatures. There are 10 states which have begun the process of getting the bill passed; Missouri has already passed the bill. We need six more states to create the Commission to oversee the Compact. 
• Here is a map of the 26 states that have passed the Counselor Compact, https://counselingcompact.org/map/. These states should be open to passing the Social Work Compact as well.
• For more information on how to make your state legislators aware of the Social Work Compact, go to the CSWA website at https://www.clinicalsocialworkassociation.org/Announcements/13212620.

Please let me know when you have sent messages to Congress and members of your state legislatures. Thanks for your help.

Contact:
Laura Groshong, LICSW, CSWA Director of Policy and Practice
[email protected]

​BREAKING NEWSII  WE HAVE A NEW COMMISSIONER FOR THE DEPARTMENT FOR
BEHAVIORAL HEALTH, DEVELOPMENTAL AND INTELLECTUAL DISABILITIES (BHDID)
Please see Acting Commissioner Stephanie Craycraft’s note below and extend a welcome to Dr. Katie Marks
 
Please join me in welcoming Dr. Katherine Marks to the position of Commissioner of the Department.  I know that Dr. Marks will bring the same energy, enthusiasm, collaborative spirit, and dedication to the role of Commissioner as she has her previous role as the Project Director for the Kentucky Opioid Response Effort (KORE).   Her efforts have been key to the expansion of a comprehensive, recovery-oriented system of care which has changed the lives of countless individuals in the Commonwealth who have been affected by the opioid epidemic. 
The Department’s efforts to facilitate recovery for Kentuckians affected by substance use and mental illness and to support those with intellectual or other developmental disabilities will undoubtedly be strengthened under Dr. Marks’ leadership. 
It has been a privilege to serve in the role as acting Commissioner for the past several months and to collaborate with our dedicated partners who are committed to meeting the needs of the people we serve.  I look forward to continuing to our collaboration as I revert to my role as Deputy Commissioner. 
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As of May 31st, the first round of required Medicaid renewals is in the books…and the results so far are very bad.  Despite the best efforts of KY DMS, providers, the MCOs and advocates, only 50% of the 74,004 individuals who needed to renew their Medicaid coverage by the end of May actually did so.  There were terminations of Medicaid coverage for 34,124 Kentuckians.  Of nearly 6,000 Kentuckians who then became eligible for a Qualified Health Plan on kynect, only 460 have enrolled!  24,521 individuals on Medicaid have not responded at all to letters, calls or other communications to return the required paperwork...but they still have time!! 
DMS and the MCOs will continue to reach out to those 24,000+ Kentuckians who can still easily respond and keep their coverage retroactive to May 31st.  After 90 days, they can still respond, but will need to reapply for Medicaid which will become active with their application.
We must ALL reach out to every Kentuckians we know, work with or serve to urge them to respond to their letter from DMS or to contact a DCBS office or a kynector who can help them get their Medicaid coverage and benefits going again!  

On May 11, 2023, the World Health Organization announced the end of the federal COVID-19 PHE declaration.
Unfortunately, this does not mean that coronavirus does not exist anymore, rather that Covid-realated deaths
have substantially decreased. The U.S. government’s approach to coronavirus will change, but how does this
impact social workers?
The end of the PHE has caused concern for LCSWs who work via telehealth with clients on Medicare (CMS).
Firstly, the coverage of telehealth has begun to be limited by some insurers. This is concerning because
telehealth increases access to healthcare providers, and limiting access to that may cause clients to stop
receiving the care they need. Fortunately, The Consolidated Appropriations Act of 2023 extended Medicare
coverage of telemental health until December 31, 2024 but many commercial insurers did/do not follow CMS
guidance. Secondly, after the December 31, 2024 date, clients will be required to be seen in-person at least
once a year. Due to health risks, transportation issues or more, this could be virtually impossible for some
clients. Audio-only telehealth appointments will not be covered following the The Consolidated
Appropriations Act of 2023 further alienating some clients from care.
LCSW’s who use platforms such as Skype will need to change mediums. According to the Office of Civil Rights
(OCR), using such platforms was not seen as a violation of HIPAA rules during the PHR. Now, LCSW’s will be
required to use a HIPAA compliant platform, such as ZoomPro, Doxy.me, and other platforms offer a Business
Associate Agreement (BAA).
Finally, there are changes to codes and modifiers for Medicare:
● New for CY 2023: Describes general BHI that a clinical psychologist (CP) or clinical social worker
(CSW) performs to account for monthly care integration
● A CP or CSW, serving as the focal point of care integration furnishes the mental health services
● At least 20 minutes of CP or CSW time per calendar month
○ Additionally, the modifier for Medicare claims is “GT” though “95” can be used for other
claims.

More information can be found on the Clinical Social Work Association website.
Info: https://www.clinicalsocialworkassociation.org/Announcements/13134039
https://www.clinicalsocialworkassociation.org/Announcements