Time to Advance Wholistic Health Equity Quality

In response to this growing price tag the industry has evolved a fresh generation of quality frameworks, metrics, and models to forge a more comprehensive health equity vista. However, all of these efforts fall short of that goal. Every organization and entity still uses different metrics to measure and benchmark their actions. The actions of NCQA, the National Quality Forum, and CMS (through their Health Equity Pillar) are not for naught. Yet, there remains no viable, formal roadmap adopted to align cross-sector efforts and steer a successful course toward wholistic health equity; at least not until now. 

Whole person care is the ideal model to attain health equity across populations, though current quality metrics are not aligned to the wholistic health compass. Despite decades of research and successful outcomes, Integrated care’s domains of physical and behavioral health continue to remain remain siloed. While the social determinants of health and mental health (SDoH and MH) dramatically impact health and behavioral health outcomes across every practice setting, they are inconsistently factored into national quality models. 

What Comprise the WHEDs

Systemic racism, historical, developmental, and event traumas are also well recognized in the literature as correlates of health disparities. The Political Determinants of Health (PDoH) add their fury to the fire by fueling worsening clinical outcomes as a person’s social position decreases. Yet despite these facts, the US health system lacks a unified health equity vision that consistently includes assessment of these fundamental constructs. Add systemic racism, and the PDoH to the SDoH and SDoMH, and we gain a comprehensive lens for addressing health disparities: wholistic health equity determinants (WHED).

The WHED contribute to poor clinical outcomes and fiscal losses across each touchpoint of care though increased chronic illness severity, morbidity, mortality for every life stage. Vast differences appear across rural and urban regions. Safety-net hospitals have profoundly higher hospitalization utilization rates for length of stay, intensity of treatments, and costs, including readmission rates and associated penalties.

ACEs, historical, developmental, and other event traumas increase onset and exacerbation of chronic respiratory illnesses, diabetes, obesity, and mortality. Members of the LGBTQIA++ population are at higher risk than other groups of developing severe mental illness, and for experiencing an exacerbation or new onset of mental illness. Reasons for these disparities include the community’s chronic exposure to implicit bias, discrimination, and racism, as well as increased social isolation and exposure to interpersonal violence.

Given the realities addressed above, anything less than a vantage focused on the WHEDs is short-sighted. This limited gaze will not enhance quality of care for the rising number of vulnerable and disenfranchised populations across the globe.

Mandate for Action

National health expenditures now exceed $4.3 Trillion annually and will further rise. I can hear some of you muttering how this number is related to the pandemic only. Here’s food for thought: pre-pandemic these numbers had already topped over $3.8 Trillion related to chronic illness exacerbation and the SDoH. The incidence of these factors has only intensified and escalated from the pandemic.

In response to this growing price tag the industry has evolved a fresh generation of quality frameworks, metrics, and models to forge a more comprehensive health equity vista. However, all of these efforts fall short of that goal. Every organization and entity still uses different metrics to measure and benchmark their actions. The actions of NCQA, the National Quality Forum, and CMS (through their Health Equity Pillar) are not for naught. Yet, there remains no viable, formal roadmap adopted to align cross-sector efforts and steer a successful course toward wholistic health equity; at least not until now. 

Advancing the Wholistic Health Equity Quality Roadmap©

Imagine an 8-step color-coded roadmap that aligns with a dedicated total quality management process. This novel framework holds organizations across sectors accountable for improving care access and provision, and can be tailored to any organization. Quality data on the front-end is culled from evidence-based screening and assessment of health-related social needs, and uses diagnostic data (e.g., ICD-10CM-Z Codes). Revenue cycle management is as vital as interprofessional intervention, inter- and intra- agency collaboration, DEI priorities, then eclipsed by use of whole-person and inclusive- population health outcomes data. 

You’ve all been patiently waiting for me to unveil my Doctoral Culminating Project, and your wait is over! My Wholistic Health Equity Quality Roadmap© will be formally unveiled in distinct versions at the upcoming industry events, including:

A 2-part article series will also be published in Wolter Kluwer’s Professional Case Management Journal this Fall. 

The industry and its stakeholders are out of options! Implementation of the Wholistic Health Equity Quality Roadmap©  at a national level is a moral, ethical, and financial imperative that will ensure inclusive, quality-driven, patient-centered, and concordant interventions for all populations.

New Book Frames a Vivid Ethics Spectrum for the Interprofessional Case Management Workforce

Case managers strive to be ethical, and can recite the industry’s ethical tenets of autonomy, beneficence, fidelity, justice, and nonmaleficence by heart. Yet, too often case managers get caught in the crosshairs. Enter, Dr. Ellen Fink-Samnick with a timely resource and Amazon’s #1 best seller (Medical Ethics, Nursing Administration & Mgmt.) for all professional stakeholders: student, novice and more seasoned case managers, consultants, and those in leadership roles.

Ethics has long been viewed as not black and white, but rather varied shades of gray. However, these interesting times mandate a novel stance. Ethics now comprise a spectrum of vivid colors that reflect its fierce disruptions to practice, and for every member of the health and behavioral health workforce. Managing this intense reality is a constant struggle for all practitioners, especially those in case management. My latest book and Amazon’s #1 Best Seller in Medical Ethics offers clear guidance; enter The Ethical Case Manager: Tools and Tactics

Case management’s workforce faces many accountability challenges not experienced by other professions. First, case management is an umbrella profession comprised of varied disciplines (e.g., counseling, nursing, occupational therapy, and social work). Each discipline has a distinct code of ethics or professional conduct, as well as dedicated standards of practice. Let’s add another layer of complexity that includes the over 25 case management-related credentials for individuals (e.g., ACM, CCM, CDMS, CMGT-BCTM, CRC), those for organizations (e.g., NCQA, URAC)and their unique requirements. Of course, there are also a lion’s share of professional associations across the industry. The landscape gets even more precarious when including the hierarchy of case management roles that span community health workers, case management assistants, and community based case managers, to board-certified case managers, and those in leadership positions. 

The question beckons: Where should your ethical compass point? The range of established resources of guidance defined by each of the above entities makes the answer to this question challenging to answer. It also yields two confusing conundrums for the workforce:

  1. Defining the ethical and legal parameters for case management practice, and 
  2. Reconciling these parameters with employer policies and procedures across the industry.

Here’s where, The Ethical Case Manager: Tools and Tactics comes to the rescue. The book’s content is written for an interprofessional audience that spans the educational spectrum of degrees held by those in the field. This approach provides a context for accountability, while addressing the most complex ethical dilemmas to date. Attention is paid to workplace bullying, digital healthcare innovation, management of implicit biases, microaggressions, health equity and inclusion, plus interstate practice, and other population health situations. The pandemic’s wrath is woven within chapters where relevant. Didactic knowledge is blended with Federal and state regulations, innovative models, practice templates, and dedicated resources.

Each of the book’s 10 chapters includes real-life case scenarios and contemplation questions that allow learners to dig in and apply the content. 20 Ethical Tactics provide tangible touchpoints for learning. Every reader will reap their own reward, from students, to new or more seasoned case managers, consultants, as well as those in leadership roles.

The Ethical Case Manager’s 318 pages encompass the most vital areas for case managers:

  • Section 1: Essentials of Ethics
    • Chapter 1: Terms and Definitions
    • Chapter 2: Established Resources of Guidance
  • Chapter 3: The Value Proposition for Ethical Case Management
  • Section 2: Realities of practice
  • Chapter 4: Population-based Practice
  • Chapter 5: Diversity, Equity, Inclusion, and Justice (co-authored with Michael Garrett)
  • Chapter 6: Workplace Bullying
  • Chapter 7: Health Information Technology
  • Chapter 8: Interstate Practice
  • Section 3: Activation of Ethical Decision-making
  • Chapter 9: Enduring Models
  • Chapter 10: Case Scenarios and Direct Application
  • Epilogue

The Ethical Case Manager: Tools & Tactics will be your primary resource, whether you seek to:

  • Educate students
  • Onboard new staff
  • Benchmark ethical practice
  • Resolve ethical dilemmas
  • Guide compliance practices 
  • Ensure successful fiscal, clinical, and operational outcomes 
  • Employ ethical decision-making models
  • Leverage interprofessional teams
  • Inform individual practices


The Ethical Case Manager: Tools and Tactics is only available on Amazon and for a special introductory price of $43.18. Pricing increase to $69.99 on 5/31/23.

Attending the upcoming Case Management Society of America Conference in Las Vegas? You will have access to 2 exciting book signing events: 

  • 6/27/23-Pre-Con, Telehealth 2024: Advancing Case Management’s Practice Proficiency, 2:15-3:15 PM
  • 6/29/23-Exhibit Hall book signing at the Case Management Institute table, 11 AM to 2:30 PM. Discounted rates, bulk orders, and bundled specials will be available



15 Job Search Lessons for Health, Behavioral, and Public Health Students

Today’s job search has become complex, especially for the next generation of health, behavioral health, and public health professionals. Here are 15 lessons to activate and succeed in your actions.

It’s been way too long since I wrote a blog and now is the PERFECT time to restart this action. My Baccalaureate, Masters’ and now, Doctoral students are graduating, and ready to make their mark on the industry.

Yet it is my MSW students that I worry the most about. They face lots of considerations, especially in light of an ongoing Great Resignation and the newest dynamic of “Quiet Quitting”. How can you engage in a successful job search? What can you negotiate? Who’s interviewing who on the interview? Here are 15 lessons to activate and succeed in your job search!

Lesson 1: Organize 

Set up an electronic folder on your computer, with subfolders:

·       References

·       Cover letters

·       Interview questions

·       Submitted applications

·       Recruiter contacts

·       Key info about jobs applied for  

Track positions on a spreadsheet with information including application dates, if you heard back and when, job details (e.g., salary, key benefits, virtual or in-person, multiple sites), contact information. I’m a fan of Excel, but how to organize is up to you!

Lesson 2: Keep your resume focused, comprehensive, and competency-based.

A resume is your professional face. In your zest to post and send it to potential employers, it becomes easy to include too much info, be too wordy, or use unprofessional language. Think:

· Formatting: Use a resume template, plus career planning offices at your college or university, and:

o Indeed.com

o  The New Social Worker 

o  ResumeGenius  

· Use competency-based language: Professions have competencies that are viewed as the pillars of practice. Use that language to describe roles for practicums, internships, or professional jobs; for example, ‘intervened with adolescent population’ instead of ‘worked with adolescents’. Another example is, ‘engaged in counseling’ instead of ‘provided, or did counseling’. Competency-based language also lives in course syllabi and licensure regulations for your state.

· Attention to detail matters: A resume is your first impression to perspective employers. If there are errors, they will wonder, ‘if you can’t take the time to proof your own resume, why should they believe you’ll do better on the job?’. Do spelling AND grammar checks!

Lesson 3: Have references ready!

Reach out early to references and keep their current contact information accessible! Maintain professional letters of recommendation in your online files. Keep references in the loop so they know to expect any calls or emails for information about you. With so many phishing emails, everyone is cautious about providing information. Your reference can easily miss a vital request to provide the recommendation that leads to a job offer!

Lesson 4: Know what matters to the organization

This lesson is two-fold: first, keep up on public health facts and their impact for populations served by the agency. Brush up on Crisis theory, Trauma-informed care, and short-term counseling techniques. This info will help you develop ideas on how to best serve the organization. Knowledge is power; this is a great way to tout your expertise in the interview.

Second, ask what DEIJ (Diversity, Equity, Inclusion, and Justice) initiatives the organization has in place; this information goes beyond what may be on the employer’s website. You want to know exactly what initiatives have been put in place to ensure all employees, patients and clients, and other stakeholders feel included, safe, and experience a sense of belonging in their interactions with the entity.

Lesson 5: Know brief assessment tools and resources

With the uptick in mental health across populations and the workforce, have working knowledge of assessment tools to manage anxiety, stress, and depression. Quality resources live at Therapist Aid and AHRQ

Lesson 6: Interviews are reciprocal opportunities

Interviews are not a guarantee of employment. Candidates can spend so much time during an interview discussing their expertise, they forget to ask key questions about the workplace.

Research employers before the interview. View the employer’s website to learn their mission, vision, and goals. Learn how the organization conducts business. Ask questions about short and long term goals, and how they see you fitting into these plans. This tactic conveys your interest in the position. Interviews are for potential employers to interview you, but also you to interview them. This mindset puts you in control of the process, and decreases anxiety. Ask questions to learn if this job and setting are for you, such as those at Big Interview

Remember, decision-making timeframes vary, so ask about next steps. Organizations can take 2 days to make final decisions or months! Know what you are facing to help prioritize other offers!

Lesson 7: Ask about job stability

Amid these unpredictable times, it’s appropriate to ask about potential layoffs and furloughs. Some positions are funded by grants, so ask how long the position is funded and what happens next; this is especially true of the termination of Covid-19 emergency declarations. Hiring freezes are still common and won’t necessarily be information shared. If you don’t ask, you won’t know.

Lesson 8: Be ready to name your unique strengths, and demonstrate them 

Job candidates will be asked how to handle specific situations. Identify your strengths and how they would make a difference. Consider:

·       How do your strengths set you apart from other candidates?

·       Why should the organization hire you?

·       What examples can you provide so the employer understands your worth?

·       How can you demonstrate your ability to work with a team?

·       You will be asked about your weaknesses. Be prepared to respond in a professional manner, and have your answer ready. 

Lesson 9: The only constant in our industry is change 

You might be happy to NOT be in school for a bit, but be open to new learning: the industry will change as will you; be open to what it means for you to change with it.

Lesson 10: Be open to short-term or part-time roles

An exciting short-term or part-time role may turn into the best career option never anticipated. In these interesting times, more MSWs are accepting multiple part-time positions. This option can promote greater flexibility, while minimizing burn-out. Also, don’t dismiss positions that are different from your expectations!

Lesson 11: Set up your professional social media profile. 

Set up a professional profile using established websites and job bank platforms. Facebook (or Meta) can help with networking, but use other websites that highlight recruitment:

Keep a profile professional! Use a polished photo versus a selfie with your BFF, pet, or family! Solid guidance is at What Recruiters Want to See on Your LinkedIn Profile

Lesson 12: Negotiation is expected

Negotiation is expected for any job. Negotiate for everything:

  • A higher hourly rate or salary
  • Remote options or flexible work hours
  • Coverage/reimbursement for professional fees (e.g. licensure exam application, exam prep courses, professional association dues)
  • Coverage/reimbursement for clinical supervision and if it is offered onsite. Organizations may pay a portion of the rate to the whole amount. They may only provide supervision internally or have waiting lists. If supervision is provided, you may need to promise to stay at the organization for set number of years post-completion, or pay pack a set amount.

You don’t know what you don’t know, so ask questions! The answers may surprise you! 

Lesson 13: Don’t be thrown by a title or position qualifications 

People apply for jobs based on titles; titles are deceptiveLearn about the scope of each role before dismissing a solid opportunity. 

Don’t dismiss a role based on qualifications alone. Application processes may ‘kick you out’ for not having hard competency qualifications (e.g., degree, licensure). Other knowledge or experiences can sway the decision; volunteer roles and practicums with a population speak volumes. Don’t assume you’re not qualified!

Lesson 14: Take the right job, not just any job

You want an income when you graduate, but strive for the right job. Listen to your clinical gut during the job search. Don’t jump on the first offer or settle if something feels off. Process the opportunity with peers, former professors, and mentors. We may be amid the Great Resignation, but, the grass isn’t always greener; there are brown spots everywhere. 

Lesson 15: Enjoy the job search

There is pressure to be employed, but explore opportunities. Get out there and enjoy the search!

I invite colleagues and followers to post other practical lessons below to empower our next generation of professionals!

Photo by Pixabay on Pexels.com
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