Success in today’s business world is often measured in numbers—productivity rates, operating margins, and outcomes. But what if the key to sustainability and growth lies not in traditional metrics, but in how well an organization understands and responds to the well-being of their employees? Trauma-informed care (TIC) has long been applied to clients and patients in treatment settings. However, it is not just a compassionate approach; it’s a strategic focus that transforms workplaces into environments where psychological safety drives innovation, loyalty, and stronger outcomes. This is the business of healing—a new paradigm in organizational strategy.

Trauma-informed care has traditionally focused on understanding the client or patient’s history to develop effective treatment plans. However, through the work of Children & Families First Delaware’s Brain Science Training Institute, we see greater opportunity for impact. We have found that staff also experience adverse events and struggle with their own mental health concerns. This is consistent with the data, with nearly two-thirds of U.S. adults experiencing one or more adverse childhood experiences (ACEs), and one in five living with a mental health concern. Recognizing and addressing the well-being of staff, and building their resilience, supports a stronger workforce. Staff often feel validated and express gratitude when their organization acknowledges the importance of trauma-informed care in their training programs. While staff naturally want their well-being to be valued, from an organizational perspective, having regulated and supported staff leads to fewer mistakes, better project planning and implementation, and a more measured response to workplace stressors.

The traditional model of trauma-informed care views it as a linear journey from being trauma-aware to trauma-sensitive, responsive, and finally trauma-informed. However, our consultations have revealed that organizations don’t fit neatly into these categories. We assess various aspects during our consultation process, such as staff development, wellness, physical environment, policies, and client services. Often, an organization may be responsive in some areas, while only aware or sensitive in others. Conducting a comprehensive assessment helps identify key action points. However, it is clear that everyone—from administrative staff to facilities and finance—needs training. Leadership is crucial to this journey as well, as many TIC initiatives require their approval and implementation. Without leadership’s commitment, the success of TIC efforts will be limited.

“How do I balance compassion with accountability?” is a common and valid concern when discussing trauma-informed care in the workplace. Trauma-informed care is not about leniency; it’s about mutual accountability—holding both staff and leadership responsible for creating a respectful and supportive environment. In a trauma-informed organization, values and principles guide every interaction, not just with clients or consumers, but within the team. Leaders embrace mistakes as opportunities for growth, foster open dialogue, and create space for tough conversations. From the outset, clear boundaries and role expectations are established, ensuring transparency. When performance concerns arise, goals are explored collaboratively, and issues are addressed constructively to promote both individual and organizational growth.

To truly embrace this paradigm, leaders must ask themselves some crucial questions:

  • Is your team comfortable taking risks and experimenting, even if it means they might fail?
  • Do they feel a sense of connection and camaraderie with one another?
  • Are they more inclined to collaborate and support each other, or do they compete for individual success?
  • And most importantly, are they encouraged to provide constructive feedback to you and the organization?

These questions are essential for shaping a strategy that ensures staff feel supported and valued as integral parts of the organization.

At the Brain Science Training Institute at Children & Families First, we believe the well-being of staff is the cornerstone of organizational success. Our comprehensive training and consultation services are designed to support organizations in implementing trauma-informed care practices that foster a supportive and innovative workplace. Whether you are in the social service sector or any other industry, a trauma-informed approach can transform your organization into a place where every team member feels values. Contact us today to learn about how the Brain Science Training Institute can support your journey.

CFF is the winner of Social Current’s 2024 Innovative Impact Award. To learn more, read our article and watch their video interview.

About the Authors

Kiera McGillivray, LMFT
Kiera McGillivray is a Licensed Marriage and Family Therapist and serves as the chief program officer for school-based initiatives at Children & Families First Delaware. Kiera is trained in several trauma-focused modalities including Eye Movement Desensitization Reprocessing (EMDR), Trauma-Informed Yoga, Trauma Focused Expressive Arts Therapy, and Child-Centered Play Therapy with a Neurorelational Emphasis. Kiera has been published in internationally peer-reviewed journals on the topics of trauma and child development, and has presented on topics such as trauma, resilience, and ethics to diverse audiences, including military personnel, clinicians, educators, law enforcement, and victim service professionals. She is a graduate of Social Current’s Executive Leadership Institute. Kiera serves as a clinical supervisor and co-director of the Brain Science Training Institute.

Shannon Fisch, LCSW
Shannon Fisch is a Licensed Clinical Social Worker in the state of Delaware and is the director of operations and risk management for Children & Families First Delaware. She received her post-graduate certification in trauma from Widener University, received her nonprofit management certification from University of Delaware, and graduated from Social Current’s Executive Leadership Institute. Shannon is trained in several evidence-based treatment models, including Trauma-Focused Cognitive Behavioral Therapy (TFCBT). She is an avid volunteer in her profession, previously serving as president, secretary, and treasurer for the National Association of Social Workers – Delaware Chapter. Shannon is also a clinical supervisor and co-director of the Brain Science Training Institute.

The White House recently held a convening on child care to discuss state actions to improve the affordability of child care for working families, increase the number of child care providers, and improve child care workers’ job quality.

Lawmakers and organizations from 34 states across the country reflected on key strides, pathways for growth, and challenges faced within child care and early childhood education throughout the past year. State leaders discussed potential legislation to serve a greater number of working families, lower costs, and support providers. Key issues that were discussed included early childhood education teacher compensation and benefits, supply-building strategies, access and affordability of child care, and quality care assurance.

White House officials thanked state legislators for their leadership and expressed the Biden administration’s support for continued federal and state action to improve access to affordable, high-quality child care and support child care providers.

New Report on Maternal Health Care Access in Medicaid Managed Care

The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued a report surrounding Medicaid managed care enrollees’ access to maternal health care. The review was conducted because of the country’s maternal health crisis, which is marked by significant racial and geographic disparities in maternal deaths and complications. The report emphasized the importance of Medicaid as the nation’s largest maternal health care payor.

States use provider coverage rules and network adequacy standards to ensure that Medicaid managed care enrollees retain adequate access to care. However, the OIG found states are not leveraging managed care provider coverage requirements and network adequacy standards to promote access to maternal health care services that can support improved maternal and infant health.

Specifically, many states do not cover mental health providers and professionals outside of OB-GYN physicians and hospital births, including midwives, maternal-fetal medicine specialists, doulas, and community health workers, some of whose services are federally required.

Other states were found to not utilize network adequacy standards, including time and distance requirements, which limit the distance enrollees should have to travel to visit their provider. Additional standards included appointment wait times to reduce how long patients wait for a visit and provider to enrollee ratio standards, which dictate the number of providers that networks must have in proportion to number of enrollees.

Vitally, some states lack data on how the standards impact enrollees’ access to maternal health care. The OIG accordingly recommends the Centers for Medicare & Medicaid Services (CMS) confirm all states cover required services from maternal health care providers for Medicaid managed care enrollees. They additionally recommend clarifying the requirement that States have a provider-specific OB-GYN network adequacy standard and supporting states in tailoring their network adequacy standards to better address maternal health care needs.

CMS agrees with each of OIG’s recommendations and is expected to respond with a plan of action within six months. CMS is planning outreach with states to ensure managed care enrollees have access to all required maternal health services. The agency will also assist states in adjusting network adequacy standards to meet the needs of residents in their states.

Final Guidance for Second Cycle of the Medicare Drug Price Negotiation Program

The Department of Health and Human Services recently released guidance outlining the process for the second cycle of negotiations under the Medicare Drug Price Negotiation Program.

The guidance centers how Centers for Medicare & Medicaid Services (CMS) will assist Medicare beneficiaries in accessing needed medications once negotiated prices become effective in 2026 and 2027, respectively. It discusses the requirements and parameters for how participating entities, including pharmacies and mail order services, will ensure designated Medicare Part D beneficiaries will have access to the negotiated prices.

The guidance also contains a key safeguard to ensure access to the maximum fair prices by allowing CMS to engage with a Medicare Transaction Facilitator to ease data sharing. Drug companies will also have access to the Facilitator for optional, voluntary payments between eligible individuals with Medicare and the pharmacies that serve them.

The next 15 medications covered by Part D for the second cycle of negotiations will be announced by February 1, 2025, while the negotiated prices will be effective beginning January 1, 2027. Fifteen patient-focused roundtables and one town hall meeting will also be held through spring 2025.

For additional information, CMS issued a fact sheet.

Additional Steps to Lower Prescription Drug Costs
HHS additionally released a request for information and a sample list of prescription drugs that the agency preliminarily intends to include under the proposed Medicare $2 Drug List Model, a key strategy within President Biden’s broader efforts to increase healthcare affordability and accessibility.

The Model provides a fixed copayment of no more than $2 for a month’s supply per drug for eligible Medicare Part D beneficiaries. The medications are intended to treat common conditions, such as high cholesterol and high blood pressure.

The Center for Medicare and Medicaid Innovation has released the plan with the intent of determining whether a simplified approach to offering low-cost, clinically important generic drugs can improve medication adherence, lead to better health outcomes, and improve satisfaction with the Part D prescription drug benefit among people with Medicare and prescribers.

Participation in the model is voluntary for Part D sponsors and, pending further development, is estimated to start as early as January 2027. Comments may be submitted until Dec. 9.

Updates from the Judiciary

Growing Concern of Social Media’s Impact on Adolescent Mental Health
Fourteen attorneys general, led by officials in New York and California, individually filed lawsuits against TikTok, claiming the social media platform damages young users’ mental health and collects the data of users younger than 13 without parental consent.

The bipartisan coalition alleged TikTok violates safety laws by claiming the platform is safe for youth, despite addictive features like 24/7 notifications and video autoplay. The filings also highlight dangerous TikTok challenges.

The legal coalition includes the attorneys general of California; Illinois; Kentucky; Louisiana; Massachusetts; Mississippi; New Jersey; New York; North Carolina; Oregon; South Carolina; Vermont; Washington; and Washington, D.C.

The lawsuit follows the passage of the Kids Online Safety Act (KOSA) through the House Energy and Commerce Committee and the Senate, which expressed overwhelming support as 91 Senators voted in favor. KOSA is intended to boost online privacy and safety for children, regulating the features offered and reducing the addictive nature of the platform. Nevertheless, bipartisan concerns have been raised of censorship and the suppression of free speech.

Federal Judge Removed from a Thirteen-Year Lawsuit Against Texas’ Child Protective Services
The Fifth Circuit Court of Appeals unanimously voted to remove Judge Janis Jack, a federal judge for the U.S. District Court for the Southern District of Texas. The Fifth Circuit detailed several instances in which Judge Jack was disrespectful and antagonistic toward Texas state employees and their lawyers. The Fifth Circuit judges maintained she inappropriately urged and instigated lawyers representing foster care children to provide evidence that Texas is willfully disregarding her orders for systemic improvements.

Judge Jack’s removal primarily follows the expansive reforms she mandated after determining Texas’ foster care system violated children’s constitutional rights. She levied heavy fines when state officials failed to meet compliance standards and found the state in contempt three times for failing to address unsafe conditions.

In April, Judge Jack issued a ruling that found Texas Department of Health and Human Services Commissioner Cecile E. Young, in contempt of her court orders to fix the way the state investigates complaints by children in its care. Her ruling carried a daily fine of $100,000 until the state could demonstrate an attempt to address its routine neglect of investigations into allegations of abuse and neglect of children in foster care.

The Fifth Circuit blocked that fine two days after Jack’s ruling and recently reversed it, maintaining it violates the court’s constitutional limits of power over individual states. The Fifth Circuit further affirmed federal judges do not have the power to become de facto superintendents, permanently overseeing major state agencies. Moreover, federal courts are not allowed to thwart the state’s self-management as they work to address identified abuses.

Subscribe to the Policy and Advocacy Radar to receive our biweekly policy roundup, which includes commentary on issues in Social Current’s federal policy agenda, opportunities to take action, and curated news and opportunities.

COA Accreditation, a service of Social Current, has revised its standards for Opioid Treatment Programs (OTP) in the U.S. in response to SAMHSA releasing revised rules for OTPs, which went into effect on Oct. 2.

Social Current staff worked closely with SAMHSA and COA Accredited OTPs to ensure the updated standards reflected these rule changes and current practice in the treatment of opioid use disorder with medications. The new rules and revised standards expand access to care, including expanding access to take-home medications, split dosing, and telehealth. They also improve a person’s experiences as they seek treatment for substance use disorder by removing stigmatizing language and promoting the chronic disease model of management, a more person-centered approach to treatment, and harm-reduction.

The 2024 edition of the OTP standards is now available on the Social Current website.

Download a copy of the revised standards.

Questions?

If you are pursuing accreditation or re-accreditation, contact your accreditation coordinator.

If you are seeking accreditation for the first time, join an upcoming informational webinar or contact Joe Perrow, network growth manager at Social Current.

For additional information about COA Accreditation standards, contact Melissa Dury, director of standards at Social Current.

Cover image of the 2023 Year in Review report

2023 set the stage for Social Current’s growing work to increase understanding, awareness, and respect for our sector and its myriad contributions. We were proud to announce our social impact campaign in partnership with UnCharitable and hold our first-ever Hill Day, recognizing the urgent need to dismantle barriers that obstruct our sector to effectively address pressing social issues. We are grateful to have your support as we continue to strengthen and amplify the work of the social sector to facilitate impact and systemic change through our core solutions and impact areas.

Our 2023 Year in Review features:

Download the full report.

Lardie to Lead Multi-Faceted Development Strategies Across Social and Human Services Funders and Foundations

Headshot of Sarah Beth Lardie
Sarah Beth Lardie

Social Current today announced that Sarah Beth Lardie has joined the organization as chief development officer to oversee and coordinate funding and development strategies across a broad range of social sector and human services funders and foundations.

With nearly two decades of experience in advancing the mission, vision, and goals of nonprofit organizations, Ms. Lardie has helped to lead the growth and sustainability of a wide range of successful organizations, raising more than $20 million dollars annually for civil society actors ranging from United Nations to local food banks. She began her career as a social worker working with children and families before transitioning to a career in development. As a member of the founding leadership team of Joshua Venture, a fellowship program for social entrepreneurs, she was responsible for providing fellowships for 16 entrepreneurs across the U.S. She has also been a mentor with MIT’s LaunchX program and an advisor to the African Venture Philanthropy Network.

“Sarah Beth’s extensive experience in development and her understanding and familiarity with the social sector as a social worker will help us grow our strategic partners across the sector,” noted Jody Levison-Johnson, president and CEO of Social Current. “She will be a critical asset in our efforts to activate the power of the social sector to help build an equitable society where all people can thrive.”

“Building civil society, bringing more people and resources to the critical work being done is fulfilling,” commented Sarah Beth Lardie. “Nonprofit organizations are where innovations to solve society’s most difficult problems are happening, and I love being part of that. That’s what drew me to Social Current.”

Lardie received her bachelor’s in sociology and labor studies from Rutgers University, her master’s in social work from the Columbia University School of Social Work and her master’s in public administration from Carnegie Mellon University/University of Pittsburgh in a dual degree program. She is based in New York City.

The Office of Management and Budget (OMB) recently released guidance, effective Oct. 1, to reduce the barriers organizations face in accessing government grants. The revisions are intended to offer clarity and improve the readability of funding opportunities through plain, concise, consistent language. They are also expected to address longstanding challenges to recovering actual costs and reduce the burdens and costs of seeking, performing, and reporting on federal grants.

A few key provisions are highlighted below:

  • Encourages community engagement
  • Recommends considering diversity when developing merit review panels
  • Permits language translations of programs and awards
  • Allows federal agencies to offer pre-application technical assistance or provide clarifying information for funding opportunities
  • Includes tribal organizations as an example of potentially eligible applicants
  • Increased the single audit threshold to $1 million

Notice of Funding Opportunity: Funding details, an executive summary, and key dates will be required to be listed at the top of the notice before the announcement’s full text.

Reimbursement for Indirect Costs: Passthrough entities, often states and local governments and occasionally larger nonprofits, that use federal funds and all federal departments and agencies are required to reimburse a nonprofit for the reasonable indirect costs incurred performing services on behalf of governments.

15% Minimum Rate: Federal grants are now required to provide the guaranteed minimum (de minimis) rate for indirect costs of 15% of modified total direct costs. Federal agencies cannot compel recipients and subrecipients to use an indirect rate lower than the 15% de minimis rate unless required by statute. While organizations may choose not to utilize the 15% minimum, they cannot be forced to.

Mandated Application: Nonprofits are allowed to negotiate a higher rate through a negotiated indirect cost rate agreement (NICRA). Passthrough entities are then required to accept a grantee’s NICRA, although it remains subject to statutory and a few other limitations. Nonprofits with negotiated rates with one federal agency must be paid that same rate by all other federal, state, and local government agencies.

Right of Appeal: Receipts and subrecipients are now empowered to notify OMB of any disputes over how a federal agency applies or accepts their federally negotiated indirect cost rates or fails to pay the minimum indirect cost rate. For the first time, nonprofits can turn to OMB for help when federal agencies are not following the law.

Upfront Payments: Once financial and written procedures are met, the recipient or subrecipient of federal grants must be paid in advance. Meanwhile, reimbursable grants are preferred only when those requirements cannot be met. The guidance offers key flexibility as governments can be encouraged to make advance payments to nonprofits, rather than assuming that reimbursable grants are their only option or default.

Reporting Requirements: Federal agencies are instructed to eliminate reports that are not necessary to effectively monitor the grant. By encouraging agencies to only measure things that matter, nonprofits are able to redirect their efforts from burdensome, needlessly complex reporting requirements toward serving their communities.

Continuing Resolution Approved, Preventing a Government Shutdown

The U.S. House of Representatives and Senate negotiated a bipartisan continuing resolution to continue funding the government until Dec. 20. President Biden signed the bill shortly afterward. Congress has since adjourned and will return to session Nov. 12 to negotiate spending agreements on FY2025 spending bills funding key services, including housing and transportation.

A few of the programs and services that will continue to receive funding are included below:

  • U.S. Federal Emergency Management Agency Disaster Relief Fund
  • Supplemental Nutrition Assistance Program replacement benefits for victims of card skimming
  • Temporary Assistance for Needy Families
  • Special Supplemental Nutrition Program for Women, Infants, and Children
  • Commodity Supplemental Food Program
  • Tenant-Based Rental Assistance through the Department of Housing and Urban Development’s Public and Indian Housing Department
  • Developmental Disabilities Surveillance and Research Program
  • Autism Education, Early Detection, and Intervention
  • Medicare Improvement Fund
  • Extension of Funding for Health Care and Housing Programs That Serve Veterans

Executive Order to Address Emerging Firearms Threats and Improve School-Based Active-Shooter Drills

President Biden recently issued an executive order to address emerging firearms threats, including by preventing unauthorized access to firearms for youth and individuals in crisis. The order strives to address the mental health needs of students, particularly those impacted by gun violence. It also intends to support schools that are implementing evidence-based safety and gun violence prevention and intervention solutions.

The executive order additionally created an Interagency Emerging Firearms Threats Task Force to develop a risk assessment and strategy to stop the proliferation of machine gun conversion devices and address the emerging threat related to 3D printed firearms. Additionally, it directs key government agencies to develop and publish information about school-based active shooter drills for schools, including the appropriate frequency of such drills and the effects of such drills on students and educators.

Throughout, President Biden enforced the importance of an integrated approach to promoting the safety of students and educators, uniting the Department of Justice, the Department of Health and Human Services, the Department of Education, and the Department of Homeland Security.

House Ways and Means Committee Holds Hearing on Reforming Temporary Assistance for Needy Families

Chairman Jason Smith (R-Mo.) highlighted the House Ways and Means Committee’s efforts to promote stable, prosperous lives for families, including by reforming direct cash assistance. He stressed the importance of restoring integrity and accountability to Temporary Assistance for Needy Families (TANF) as he lamented waste, fraud, and abuse. Chairman Smith discussed the importance of guardrails to ensure funds are directed to those in need, including through data collection.

Ranking Member Richard Neal (D-Mass.) echoed the profound impact TANF funds can have on the well-being of families and the importance of ensuring families receive the assistance they deserve. He affirmed the importance of a multifaceted approach, including through an expanded Child Tax Credit, guaranteed child care, and paid family and medical leave.

Sam Adolphsen, policy director of the Foundation for Government Accountability, and Brett Favre, a former professional football player, spoke of the positive impacts of TANF through economic growth and falling rates of childhood poverty. They also discussed egregious instances of fraud, waste, and abuse associated with TANF funds and emphasized the importance of addressing loopholes that allow the misuse of funds. They recommended rebalancing program spending on work-related activities to combat fraud alongside increased accountability, oversight, and stronger guardrails.

Jarvis Dortch, executive director of the American Civil Liberties Union (ACLU) of Mississippi, echoed the presence of widespread abuse and fraud of TANF funds in Mississippi. He recommended policies that verify families in need are receiving assistance and stressed the importance of directing funds toward programs that meet the spirit of TANF, including quality child care and access to transportation. He warned of the harm of redundant verification systems while encouraging innovative programs to advance employment and assist low-income families. Dortch also urged the committee to pass legislation creating a TANF ombudsman program, which would be able to ensure compliance, monitor misspending, and gather data.

Representatives discussed potential reforms to ensure TANF-funded programs help those most in need while safeguarding against fraud and abuse. Representatives and witnesses also discussed the importance of work, underscoring the lack of requirements, incentives, and minimum standards for state spending on work, education, and training activities among TANF’s non-assistance funds. The hearing follows a report issued by the Government Accountability Office outlining preliminary observations on state budget decisions, single audit filings, and fraud risks within TANF.

Sector Updates from the Judiciary

Salary Tests Upheld for Overtime Pay
A Texas businessman recently challenged a rule issued by the Department of Labor in 2019. The rule raised the required minimum weekly salary to qualify for the exemptions for executives, administrators, and professionals (EAP) by more than 50%, from $455 to $684 per week.

On Sept. 11, 2024, the U.S. Court of Appeals for the Fifth Circuit ruled in favor of the U.S. Department of Labor. They affirmed the department’s authority to use a salary basis to define its white-collar overtime exemptions and to define the professions classified within the EAP exemptions.

The ruling establishes key precedent to defend the recently published April 2024 rule to further increase the minimum salary requirement for the EAP exemptions in similar legal challenges. Nevertheless, potential challenges to the 2024 rule remain, including from a Texas district court that has temporarily prevented the rule from taking effect for the state government’s employees.

The 2024 DOL rule raised the minimum weekly salary to qualify for the EAP exemption from $684 per week to $844 per week, or the equivalent salary of $43,888 per year, on July 1, 2024. Salaries are set to rise again on Jan. 1, 2025, when the minimum salary will increase to $1,128 per week, the equivalent of a $58,656 annual salary. Under the rule, the salary threshold would increase every three years based on up-to-date wage data.

For more information on the rule and employee classifications, view the Department of Labor’s fact sheet.

Student Loan Forgiveness Remains on Pause
Judge Hall, a judge for the District Court for the Southern District of Georgia, recently moved a challenge to President Biden’s student loan forgiveness plan from Georgia to Missouri. The challenge was brought by a coalition of seven Republican-led states, including Alabama, Arkansas, Florida, Georgia, Missouri, North Dakota, and Ohio.

Biden’s plan to ease student loan debt would erase up to $20,000 in interest for those who have seen their original balances increase. It would also provide relief to individuals who have been repaying their loans for 20 to 25 years.

Judge Hall ruled that Georgia failed to demonstrate it would experience harm following student loan relief. The Judge allowed the suit to be moved to Missouri, which stands to lose millions directly through the Missouri Higher Education Loan Authority, the nonprofit student loan servicer the state operates.

Judge Matthew Schelp, a district judge based in St. Louis, has since issued a preliminary injunction against President Biden’s student loan relief plan. Borrowers are not expected to witness any changes as student loan relief remains paused.

Texas Sues to Stop Biden Administration Rule Requiring Affirming Placements for Youth in Foster Care
Texas Attorney General Ken Paxton recently filed a lawsuit against the federal government claiming the requirement that states provide LGBTQ+ affirming placement for foster care youth would exacerbate the shortage of foster families.

The rule requires that child welfare agencies ensure that a foster parent is supportive of the child’s LGBTQI+ status, is knowledgeable and skilled to address the child’s needs, and is willing to provide access to appropriate resources to support the child’s well-being. Agencies are required to implement the rule by Oct. 1, 2026 as non-compliance jeopardizes Title IV-E and Title IV-B funding.

Paxton alleged the U.S. Department of Health and Human Services does not have the statutory authority to implement the rule and that it further violates the U.S. Constitution’s Spending Clause without fair notice. He additionally maintained the rule violates the Administrative Procedure Act as Title IV does not include any requirement for special accommodations for sexual orientation or gender identity.

Texas has asserted that the Texas Department of Family and Protective Services will implement the rule, but remains concerned of the potential harm to the state’s financial security and sovereignty. The suit asks the court to declare the rule unlawful, postpone its effective date, and grant a permanent injunction against its enforcement.

New Jersey Sues Hospitals Over ‘Discriminatory’ Pregnancy Drug Screens
New Jersey Attorney General Matthew J. Platkin and Director of the New Jersey Division on Civil Rights Sundeep Iyer filed a lawsuit against three Virtua hospitals in Southern New Jersey. The suit follows an investigation into complaints filed with the Division of Civil Rights by several pregnant women who gave birth at Virtua Voorhees Hospital. The patients were drug tested without informed consent after being admitted to the labor and delivery and high-risk obstetrics units.

The lawsuit claims the hospital’s mandatory drug testing policy violates the New Jersey Law Against Discrimination and the state’s right to privacy. Iyer underscored the potential trauma of the policy, as several families faced lengthy investigations for child abuse following screenings that incorrectly indicated drug use. Once the results were shared with New Jersey’s child welfare agencies, several individuals experienced unannounced home visits and some patients were not allowed to be discharged with their babies.

The lawsuit asks for an injunction to stop Virtua’s universal drug testing policy for pregnant patients and civil penalties against the South Jersey hospital system, including compensatory damages.

Subscribe to the Policy and Advocacy Radar to receive our biweekly policy roundup, which includes commentary on issues in Social Current’s federal policy agenda, opportunities to take action, and curated news and opportunities.

On Sept. 9, President Joe Biden and Vice President Kamala Harris announced a rule that is expected to significantly advance parity for mental health care coverage. The protections will ensure mental health care coverage for 175 million Americans is on par with their physical health care coverage.

As President Biden stated, “Mental health care is health care. But for far too many Americans, critical care and treatments are out of reach. Today, my Administration is taking action to address our nation’s mental health crisis by ensuring mental health coverage will be covered at the same level as other health care for Americans. There is no reason that breaking your arm should be treated differently than having a mental health condition.”

The rule builds on the bipartisan Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). MHPAEA fortified key protections to ensure group health plans and health insurance issuers that provide mental health or substance use disorder benefits do not enact less favorable benefit limitations compared to their medical/surgical benefits. 

The rule requires health plans to evaluate their mental health care access, including assessing provider networks, payment rates for out-of-network providers, as well as using prior authorizations. It must then act accordingly to provide needed changes, potentially by expanding its network of mental health professionals or reducing bureaucratic hurdles. Health plans are also required to use similar factors in setting out-of-network payment rates for mental health and substance use disorder providers as they would for medical providers.

The above protections, and the inclusion of non-federal governmental health plans, are critical steps to increasing the accessibility and affordability of mental health care. For additional information, please see the U.S. Department of Labor’s general fact sheet as well as explanations for participants/beneficiaries, providers, and plans and issuers. The White House has also made a fact sheet available.

Addressing Food Distribution Shortages in Tribal Communities

On Sept. 11, the House Committee on Appropriations held a Joint Oversight Hearing titled “Severe Food Distribution Shortages in Tribal and Elderly Communities.” Representatives discussed the shortage crisis caused by the U.S. Department of Agriculture (USDA)’s consolidation of warehouses supporting the Food Distribution Program on Indian Reservations (FDPIR) and the Commodity Supplemental Food Program. The programs collectively serve approximately 800,000 individuals, ensuring dietary staples are received monthly.

Witnesses detailed how the consolidation, and resulting food shortages, jeopardized the welfare of their communities through extended delivery delays, missing items, and receipt of damaged and expired food. The USDA offered temporary solutions, but most were inaccessible to tribes. While temporary funding provides short-term relief, it does not address the inherent problems that stem from relying on a singular warehouse and distribution center.

Recommendations included a permanent expansion of the FDPIR pilot program, including by expanding the program to the Commodity Supplemental Food Program. The Honorable Darrell G. Seki Sr., chairman of the Red Lake Band of Chippewa Indians, additionally recommended moving to a regional sourcing model as well as establishing an automatic tracking system for deliveries.

USDA Secretary Tom Vilsack affirmed the USDA’s commitment to ensuring access to safe and nutritious foods as well as better partnering with tribal nations to empower tribal food sovereignty. Secretary Vilsack acknowledged past failures and discussed efforts to resume and improve programs immediately as well as in the short and long-term future. He further echoed the importance of consistent communication and outreach through consultations and feedback, especially in developing a more resilient, reliable distribution system capable of meeting their partners’ needs.

Committee members stressed the importance of accountability considering the harm tribal communities faced and the failure to fulfill responsibilities to tribes. They collectively expressed the unacceptability of inadequate access to nutrition and the need for corrective action.

The Inflation Reduction Act and Reduced Health Care Costs for Americans

Sen. Wyden (D-Ore.) detailed the key protections the Inflation Reduction Act (IRA) has offered in increasing the affordability of health care, including price gouging penalties, the out-of-pocket cap on prescriptions through Medicare Part D, and lower premiums through enhanced tax credits. He stressed the importance of further protecting and strengthening its terms.

Ranking Member Crapo (R-Idaho) spoke of the potential consequences of the IRA, including its impact on research and development, citing the 21 medicines and 36 research programs that have been discontinued since the law’s enactment. While he affirmed the importance of capping out-of-pocket costs for seniors’ prescriptions, he stressed hidden costs, warning how tax credits would grow the deficit. Crapo affirmed his commitment to bipartisan solutions that improve health care choice, affordability, and reliability.

Theo Merkel, Director of the Private Health Reform Initiative, also highlighted concerns about the financial implications of permanently extending the premium tax credit, estimating it would add $415 billion to ACA spending over a decade. He warned that enhanced coverage could lead to reduced employer-provided insurance and suggested improving risk adjustment and direct cost-sharing reduction payments for eligible enrollees.

Kirsten Axelsen, a Nonresident Fellow at the American Enterprise Institute, echoed these concerns, cautioning that reduced revenue could hinder investments in drug development for critical areas like rare diseases and senior medications. She advocated for greater transparency in drug selection for the Medicare Drug Negotiation Program, emphasizing the need for oversight of Medicare Part D formularies to ensure beneficiary access to affordable options.

Rena Conti, Ph.D., an Associate Professor at Boston University, highlighted that provisions in the Inflation Reduction Act (IRA), including negotiation, inflation rebates, and redesign of Medicare Part D, are actually projected by the Congressional Budget Office to save the federal government $58 billion by fiscal year 2031 without harming pharmaceutical innovation. She noted that the growth in sales of COVID-19 therapeutics and vaccines could further stimulate innovation, while also increasing coverage and profits for pharmaceutical companies.

Jeanne M. Lambrew, Ph.D., Director of Health Care Reform at the Century Foundation, supported Conti’s findings, citing nonpartisan research that demonstrates how the IRA’s health tax credit provisions enhance coverage and lower costs for consumers. Lambrew urged for the extension and expansion of the IRA, emphasizing the financial burdens Americans would face without healthcare coverage and the negative impact on healthcare providers.

Judy Aiken, a 70-year-old retired nurse, affirmed the challenge to afford the medication needed to manage chronic conditions she experiences. The costs significantly impacted her quality of life, straining her family’s budget until home repairs became unaffordable. Aiken shared the reduction in price and cap on out-of-pocket expenses signify she no longer needs to choose between her health and financial stability.

Committee members discussed the potential impact of the IRA on Medicare beneficiaries, emphasizing the need to end price gouging and increase access to care. They also expressed concern of the potential for premiums to rise while centralizing the experiences of their constituents.

Key Legislation Considered in the U.S. House of Representatives

House Committees held hearings to markup pending legislation. A few of the bills heard last week are discussed below.

U.S. House Committee on Ways and Means
  • The Educational Choice for Children Act of 2024 provides taxpayers a tax credit for donations and charitable contributions to scholarship granting organizations. The scholarships are reserved for students in households with incomes at or below 300% of the median income level in their area. This bill passed the Committee with 23 Representatives voting in favor and 16 against.
  • The Find and Protect Foster Youth Act requires the U.S. Department of Health and Human Services (HHS) to evaluate protocols utilized by states to determine the location of missing foster youth. The bill further requires HHS to provide states with technical assistance in determining children’s experiences while they are missing from foster care, including providing screenings for sex trafficking and determining appropriate services.
U.S. House Committee on Education and the Workforce
  •  The Jenna Quinn Law of 2024 amends the Child Abuse Prevention and Treatment Act to redirect grant funds toward training and educating school employees, students, and community members on preventing, recognizing, responding to, and reporting child sexual abuse among primary and secondary school students. All committee members voted in favor of this bill.
  • Parental Rights Over the Education and Care of Their Kids Act, or the PROTECT Kids Act, requires any federally funded elementary or middle school to seek and acquire parental consent before changing their child’s pronouns, gender markers, or preferred name on any school form. The requirements also extend to allowing a child to change their sex-based accommodations, such as locker rooms or bathrooms. This bill was voted in favor by 22 Representatives, while 12 voted against.
  • The Healthy Competition for Better Care Act bans anti-competitive terms in facility and insurance contracts that limit access to higher quality, lower cost care. The bill is estimated to save $3.2 billion in taxpayer dollars, according to the Congressional Budget Office. The committee voted in favor of advancing the bill.
  • The Transparent Telehealth Bills Act of 2024 amends the Employee Retirement Income Security Act of 1974 to prohibit increased payments for telehealth services provided through hospital facilities. The bill unanimously passed the House Committee.
Energy and Commerce
  • The Kids Online Safety Act establishes protections to prevent or mitigate harm from social media platforms, including through default safety settings and increased transparency for parents. The bill was approved by the Innovation, Data, and Commerce Subcommittee and will be sent to the Committee on Energy and Commerce.
  • The Children and Teens’ Online Privacy Protection Act prohibits online companies from collecting personal information from users under 17 years of age without consent. It also bans targeted advertising to children and teens and establishes a Youth Marketing and Privacy Division at the Federal Trade Commission. The bill passed Committee with a strong majority of Representatives in favor.
  • A joint resolution was introduced to prevent a federal rule that would establish minimum staffing standards for long-term care facilities and require transparency in reporting Medicaid institutional payments from being enforced. The resolution passed without amendment, with 21 Representatives voting in favor and 18 against
  • The Telehealth Modernization Act of 2024 authorizes alternative sites of services and expanded practitioners to provide telehealth services under Medicare, as determined by the Centers for Medicare & Medicaid Services. The bill was unanimously voted in favor of by the Committee.

The U.S. House of Representatives also considered the Supporting America’s Children and Families Act, which reauthorizes and amends Part B of Title IV of the Social Security Act. The bill increases the availability of community-based resources for families, including through family resource centers. The bill further centers lived experience, family preservation, and continuous improvement. The legislation was passed by a voice vote, and all representatives who spoke were strongly in favor. The Senate has since read the bill and referred it to the Committee on Finance.

Sector Updates from the Judiciary

Revisiting the Denial of Benefits for Wilderness Therapy

The US District Court for the District of Utah recently returned a lawsuit regarding the coverage of wilderness therapy to a lower court for reevaluation. United Healthcare denied coverage for wilderness therapy because of its status as an unproven treatment. However, the Court maintained their denial of benefits was arbitrary because United Healthcare didn’t provide a sufficient explanation and analysis.

The decision upholds a key provision of the Employee Retirement Income Security Act, which requires United Healthcare to provide adequate notice with specific reasons for the denial in plain language for participants. By ruling in favor of the family, the court fortified precedent mandating insurance companies include explanations of the scientific or clinical judgment used to deny the benefits.

Extended Statute of Limitations

A home health care company’s lawsuit was previously dismissed because it was filed after the six-year statute of limitations set by the Administrative Procedure Act (APA). It was reinstated, however, after the Supreme Court issued a landmark ruling in Corner Post, Inc. v. Board of Governors of the Federal Reserve System. The verdict maintains the statute of limitations does not begin until an organization is harmed by a final agency action. One of the judges dissented in part, arguing the statute limitations do not begin until the business is created.

The health care company’s lawsuit surrounds a regulation issued by the Department of Labor in 2013, which clarifies which home care workers meet the law’s minimum wage and overtime pay requirements under the Fair Labor Standards Act. Previously, the lawsuit was dismissed as the court agreed with the Department of Labor that the six-year statute of limitations began when the final rule was issued in 2013.

By returning the lawsuit to a lower court, the 3rd U.S. Circuit Court of Appeals demonstrated a key potential of Corner Post to allow organizations to challenge harmful regulations beyond the APA’s statute of limitations for civil actions.

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Through COA Accreditation, a service of Social Current, we seek to empower organizations to implement best practice standards to improve service delivery and achieve better outcomes for individuals and communities. COA Accreditation provides a framework to help organizations manage resources, incorporate best practices, and strive for continuous improvement.

We believe there is rich expertise in our field, so we ground the COA Accreditation process in our human and social services community. Our volunteer peer reviewers conduct our site visits and finalize accreditation decisions.

We are proud to spotlight the latest Volunteer of the Quarter: Sharon Gruttadauro, MSW.

About Sharon Gruttadauro

After high school, Sharon Gruttadauro followed her brother to Valparaiso University in Indiana, where she intended to study Spanish and education. That quickly changed, however, and Sharon ultimately graduated with a dual degree in social work and early childhood education. Deciding to remain in Valparaiso, Indiana, after graduation, she went to work for Youth Service Bureau of Porter County. While there, she provided group and individual support to youth in both the community and residential programs.

When Sharon and her husband moved a few towns over to LaPorte, Indiana, she began work for the Youth Service Bureau of LaPorte County. She provided group and individual support, both in the community and school settings. This was also where she began to teach parenting classes to caregivers moving through the family court system.

Sharon went on to further her education at Andrews University in Berrien Springs, Michigan. She focused her master’s studies on the administrative track rather than clinical. In doing so, she was able to begin her journey into accreditation processes; her G.A. assignment was to assist the chair of the department in their reaccreditation process.

In 1998, Sharon moved back to Rochester, New York, where she was born and raised. She began to work for Hillside. Over the past 26 years, she has served youth, adults, and families at Hillside as a clinician, care manger, quality improvement specialist, and now as clinical manager overseeing the organization’s accreditation process.

When Sharon first joined Hillside, it was going through the accreditation process with another accrediting body. It was not long, however, before the organization made the switch to COA Accreditation, now a service of Social Current. As she moved into the quality department, she became more involved in the COA Accreditation process. This is where she first learned about interpreting standards, preparing for the site visit, and the overall importance of accreditation.

Q&A

What three traits define you?

I have a passion for learning.
I am a team player, and I really care about the people in my life.
I am detail oriented.

What are your strongest beliefs about the value of COA Accreditation?

While my organization does have some programs we are required to accredit, I believe that by accrediting all of our programs we are striving for best practice. When we strive to be the best and reach the high level of COA Accreditation we position ourselves to a better provider of services to youth, adults, and families.

What advice would you give someone interested in being a COA Accreditation volunteer?

Just do it. It is amazingly valuable to you, your organization, and to the organizations you will visit.

What excites, surprises, and/or challenges you the most about the work you do as a COA Accreditation volunteer?

I love to see how different organizations interpret the standards to get the work done.

What led you to become a COA Accreditation volunteer?

Back in 2017, when I originally applied to be a peer reviewer, I was eager to learn more about the COA Accreditation review process. I wanted to truly understand the standards my organization fell under. I was also very impressed with a peer during one of our site visits. The way she spoke of the value of being a peer reviewer and the connections she made across the country really intrigued me in regard to benchmarking with top-notch organizations in the now Social Current network.

Learn more about how to become a peer review volunteer and apply online.

When the Commission to Eliminate Child Abuse and Neglect Fatalities released its groundbreaking report in 2016, much of the focus was on identifying risk factors. Since that time, however, through national initiatives such as Child Safety Forward and the response to the COVID-19 pandemic, we’ve learned that a preventive, public health approach requires an emphasis on protective factors and family strengthening policies.

With these strategies in mind, the Within Our Reach team at Social Current has developed a new Policy, Education, and Communications Toolkit that offers the latest research, resources, learnings, and tools for building a 21st-Century Child and Family Well-Being System that is based on identifying protective factors and strengthening families.

Download the toolkit for:

  • The latest insight on family strengthening policies
  • How to use framing science to effectively communicate about child welfare
  • Recommendations for parents, stakeholders, and child protective services agencies
  • Tips for advocacy efforts
  • Tips, tools, and templates for engaging media

This toolkit was created with support from Casey Family Programs and with input from a Parent Steering Committee including parents with lived experience. We invite you to share this with your constituencies and to utilize it in support of messaging and policies that will help a broad range of stakeholders continue to strengthen families through a public health response to child and family well-being.

Please download the toolkit online.

On Aug. 28, U.S. Surgeon General Dr. Vivek Murthy, released an advisory highlighting the immense stress caregivers report and the urgent need to better support parents, caregivers, and families to help our communities thrive. The report follows new and emerging challenges, including the complexity of managing social media, the youth mental health crisis, and an epidemic of loneliness that disproportionately affects young people and parents.

The surgeon general’s advisory details the relationship between parental stress and mental health, its impact, and pathways for action. Murthy recommended expanding community programs to ensure affordable child care, reliable mental health care, paid time off, spaces for social connection to build community, and encouraging communities to speak openly about the challenges parents face. He further spoke of a value shift to truly recognize the extraordinary impact of caregivers and collectively envision raising children as a shared responsibility through our policy, programs, and behavior.

The advisory highlights heightened stressors parents and caregivers face, including financial strain and economic instability, time demands, concerns over children’s health and safety, isolation and loneliness, difficulty managing technology and social media, and cultural pressures. The American Psychological Association reported that 41% of parents say that most days they are so stressed they cannot function, while 48% say that most days their stress is completely overwhelming compared to other adults.

Chronic and excessive stress experienced by parents and caregivers can adversely affect their mental and physical health, especially when considering the multiple sources of stress. Parental stress is often experienced by children, as parental mental health can influence the emotional climate, responsiveness, and consistency of caregiving, all of which are essential for a child’s emotional and cognitive development and long-term health.

The advisory stresses the importance of addressing parental mental health conditions and the underlying stressors and causes to decrease exposure to chronic or severe parental stress, empower parents to meet both their needs and the needs of their children, and reduce the likelihood of mental health conditions. The recommendations spanned community-wide from governments to employers, community organizations, health and social service systems and professionals, researchers, and families.

Biden Administration Announces Funding Awards to Advance the President’s Unity Agenda

The Biden administration recently directed significant funding toward integrating primary and behavioral health care, supporting mental health care, expanding substance use disorder treatment, and enhancing maternal mortality research and prevention efforts. The grants and funding opportunities reflect key pillars of President Biden’s Unity Agenda, including increasing the affordability and accessibility of mental health care.

Grants for Navigators to Increase Access to Health Care
The administration announced $100 million in awards to navigators to assist millions of Americans in registering for health care coverage through HealthCare.gov. The grants are awarded through the Centers for Medicare & Medicaid Services and directed toward 44 Navigator grantees in states utilizing HealthCare.gov. The grants will be offered with extended grant periods and in advance of Marketplace Open Enrollment, which will begin Nov. 1. They will be directed toward organizations working with underserved communities, consumers, and small businesses.

Funding to Integrate Primary and Behavioral Health Care and Expand Drug Treatment Court Capacity
The Substance Abuse and Mental Health Services Administration (SAMHSA) announced $81.3 million in grant awards. Approximately $16 million is directed to support the integration of primary and behavioral health care, while $24 million will expand the capacity of drug treatment courts. Additional awards will support tribal behavioral health, advance prevention science, support communities of recovery, and increase access to care through the screening, brief intervention, and referral to treatment public health model.

Prevention, Treatment, and Workforce Enhancement Awards
An additional $65.7 million in grant awards and notices of funding opportunities were announced through the Strategic Prevention Framework – Partnerships for Success program. The funds are intended to assist tribes, state and local governments, colleges, and universities in developing and delivering substance use prevention services. Additional awards will support youth with unmet behavioral health needs and increase access to behavioral health care for people who are or are at risk of becoming unhoused. The grants further aim to enhance the behavioral health workforce by supporting substance use disorder (SUD) training for graduate-level healthcare professionals.

Funding to Support Maternal Health and Home Visiting Programs
The U.S. Department of Health and Human Services announced more than $558 million in funding to improve maternal health. The vast majority, $440 million, will be directed to expand voluntary, evidence-based maternal, infant, and early childhood home visiting services. Additionally, the Centers for Disease Control and Prevention (CDC) will utilize $118.5 million across five years to expand Maternal Mortality Review Committees (MMRCs) from 46 to 52 states and U.S. territories and freely associated states.

Sector Updates from the Judiciary

Growing Challenges to Accessing Health Care for Transgender Adolescents
The 11th U.S. Court of Appeals recently upheld an Alabama bill restricting access to gender-affirming care when it declined a request to reconsider bill. Among the bill’s comprehensive provisions, it designates the prescription of puberty blockers or hormones to aid in the gender transition of individuals younger than 19 as a felony, punishable by up to 10 years in prison.

Four judges dissented, stressing the harm of restricting parents’ fundamental right to obtain medical treatment for their children. They further expressed concern for future access to broader medical care, especially if families have restricted pathways to bring legal challenges as with the 11th Circuit.

Alabama stands as one of 26 states that have adopted laws restricting or banning gender-affirming medical care for transgender youth. The U.S. Supreme Court and the 6th U.S. Circuit Court of Appeals have allowed Idaho, Kentucky, and Tennessee to enforce their bans as litigation continues. Nevertheless, a definitive ruling is largely dependent upon the Supreme Court, which has agreed to hear a lawsuit questioning the constitutionality of restricting gender-affirming care following challenges to a Tennessee bill. The legislation restricts the use of state funds for gender-affirming care and prohibits gender-affirming surgical care for minors.

Meanwhile, 16 states and the District of Columbia, have adopted shield laws to safeguard access to gender-affirming care, including by preventing providers and patients from facing civil or criminal charges from another state where care is prohibited.

Alongside the Supreme Court decision, elections are likely to significantly impact adolescents’ access to gender-affirming care. A critical example is Arizona’s election of Gov. Katie Hobbs, who issued an executive order guaranteeing insurance coverage for surgeries among state employees and protecting individuals from investigations initiated by other states. The order was issued one year after Arizona’s legislature banned gender-affirming surgeries for minors.

Mental Health Care Order Within California Prisons
The Ninth Circuit recently upheld a lower court’s ruling, affirming the right of inmates experiencing mental illness in California to have access to a minimum of 20 hours of mental health treatment per week for in-patient programs. California argued that the order did not comply with the Prison Litigation Reform Act of 1995, which requires the relief to go no further than is needed and be as non-intrusive as possible. The state also maintained that U.S. District Court Chief Judge Kimberly Mueller lacked evidence to support a 20-hour minimum.

A previous recommendation declined to set a minimum number of hours for treatment, alternatively requiring clinical assessment and treatment teams to determine all treatment decisions. Nevertheless, Judge Mueller rejected the absence of a minimum time requirement, establishing a key protection through a baseline level of care. The 20-hour minimum additionally reflects the minimum treatment levels mandated by the Department of State Hospitals, California’s state hospital system.

The decision is a key step to safeguarding the right of incarcerated individuals to access mental health care. Nevertheless, the order arrives during severe shortages of mental health professionals and despite Gov. Gavin Newsom’s longstanding efforts to expand care and recruit and retain mental health professionals.

Subscribe to the Policy and Advocacy Radar to receive our biweekly policy roundup, which includes commentary on issues in Social Current’s federal policy agenda, opportunities to take action, and curated news and opportunities.