The National Council on Family Relations (NCFR) http://www.ncfr.org/about , founded in 1938, is the oldest, multidisciplinary non-partisan professional organization focused solely on family research, practice and education.  Our 3,400 members come from more than 35 countries and all 50 U.S. states.

Ellen Taner is a featured contributor in NCFR’s publication, The Network in a column titled, “The Wheel is Moving Forward”. Following are the quarterly columns.

 The Wheel is Moving Forward­ Summer 2015

Can CFLEs Bill Medicaid for Services Rendered? 

The federal Centers for Medicaid and Medicare Services (CMS) rule enacted in January 2014, allows each state’s health plan to incorporate the rule that allows Medicaid programs to provide reimbursement of community prevention services provided by non-licensed practitioners (which may include CFLEs). Specifically, the rule states that preventive services can be services recommended by a physician or other licensed practitioner of the healing arts acting within the scope of authorized practice under state law at state option to 1) Prevent disease, disability, and other health conditions or their progression; 2) Prolong life; and 3) Promote physical and mental health and efficiency.

The ruling certainly provides opportunities for public health educators but given the important role that the family plays in behavioral and physical health, it also opens the door for family life educators to become more directly involved in providing services reimbursed by Medicaid. As a member of the National Council on Family Relations (NCFR), and the Society of Public Health Educators (SOPHE), as well as a member of the New Jersey SOPHE, I have encouraged collaboration between NCFR and SOPHE. This effort resulted in SOPHE having a representative at the NCFR 2013 Focused Dialogue session at NCFR’s annual conference in Phoenix, Arizona, and in Dawn Cassidy representing NCFR at SOPHE’s 2014 national conference.

SOPHE has encouraged their members to meet with state Medicaid offices to respond to the opportunities afforded by the CMS Ruling. SOPHE’s Advocacy and Policy Committee recently developed a toolkit for its members to use toward this effort. I wish to publicly thank SOPHE for this effort.

I am taking the opportunity of this column in the CFLE Network to issue a call to action to CFLEs and members of NCFR to develop a similar tool-kit for use in pursuing Medicaid reimbursement for family life education services. This directly fits into the overall goal of the Future of Family Science initiative.

The toolkit would provide information and resources that could be used in making the case for family life educators to be reimbursed for their services via Medicaid. The NCFR white paper, Family Life Education: A Profession with a Proven ROI (return on investment) (Cenizal, Kirby-Wilkins, Cassidy and Taner, 2014) provides a useful foundation for this toolkit. This document provides ample useful information that defines and identifies practical applications, and validates the ROI of family life education (FLE). One of the key advocacies is to offer FLE as a key universal, selective, and indicated prevention strategy for behavioral health where nothing currently exists. Behavioral health impacts include the reduction of the acuity of mental health episodes and the concomitant mental health crises for family members of those suffering from mental health disorders. Further, evidence-based FLE is a proven strategy for the prevention of the early on-set use of alcohol and other drugs by increasing the protective factors of youth and reducing risk factors. Simply by delaying the onset of use, a significant reduction occurs in the incidence of addiction and other high risk behaviors among the population that participates. This certainly provides an argument for the inclusion of family life education services in behavioral health services.

Next, the tool-kit must provide a CMS Ruling Overview. The ruling in its entirety can be found on the CMS Center for Consumer Information & Insurance Oversight Regulations and Guidance page https://www.cms.gov/cciio/. We can draw from the NCFR white paper key items included in the SOPHE Toolkit including the ROI, the definition of family life education and its importance, and details of the Certified Family Life Educator designation, outlining the provider qualifications. And we need to add a section outlining a brief overview of state government structures.

The steps to seeking the Medicaid Plan Amendment for billing must outline goals of the campaign, describe the issue and solution, explain FLE service delivery, identify opportunities and barriers, and provide additional resources. The CMS Essential Benefits Rule (CMS-2334-F) for billing of prevention services requires collaboration of CFLEs, health education specialists, prevention specialists, community health workers and others within a state.

In New Jersey, I have personally met with our state Medicaid office as well as those of the Division of Mental Health and Addiction Services, a state legislator, and a group of prevention specialists/administrators of several well-recognized prevention programs. I have made inroads for FLE to become infused into the substance abuse treatment system for clients as well as family members, and lastly, while serving on the New Jersey Behavioral Health Planning Council, I have most recently advocated that the state consider supporting efforts for Medicaid funding.

The wheel of advocacy continues to move forward. Let’s join forces and develop a tool-kit to assist in reaching the goal of making family life educator services Medicaid billable. The promotion of FLE as a recognized profession worthy of funding will take us closer to making participation in FLE the norm across the lifespan.

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The Wheel is Moving Forward Spring 2015 

Parenting and Family Education in Addiction Treatment

As a member of NCFR, the mission to include parenting and family education in new professional arenas continues to be a major focus for me. The field of addiction treatment is one where parenting and family education has been absent. While family therapy is sometimes a component of treatment, it is not the norm for family skills to be readily included. There are a few chronic disease treatment protocols that include parenting and family education but not in the treatment of addiction. Further, familial dysfunction plays a critical role in the efficacy of treatment, recovery support outcomes and the acuity of relapse when it does occur. The average person suffering with addiction relapses 7 times. The drain on the person, their family, the treatment community, and society is enormous.

I am excited to report that things are about to change in the state of New Jersey. Over the years, a major passion of mine has been to infuse family skills into addiction treatment services. It has taken a broad view of the system, many approaches, and patience.

First, I identified an evidence-based curriculum called Parenting Wisely (www.parentingwisely.com). It is flexible and cost efficient to implement and includes an in-person version for groups and an on-line version for individual sessions. Next, I spoke with several treatment providers about incorporating family skills into their addiction treatment services and was eventually successful in getting them on board with the idea. Many treatment services use counselors that are also in recovery. They understand that addiction is often a generational disease and their own children are at great risk of the disease. They were interested in the provision of the program and its skills for themselves as well as for their clients.

Although the two versions are extremely cost effective, it was important to seek potential funding sources for treatment providers to cover the costs of the curriculum. Currently there is no private or public health insurance for family education so at least covering expenses was a priority. Fortunately, New Jersey like many other states, receives federal funding to distribute to treatment providers that serve people who are underinsured or without insurance through a bureaucratic system that, although cumbersome, is flexible and lead by visionaries. That is one source that may be tapped.

Lastly, I have secured Continuing Education Units for treatment professionals who participate in the training webinar I am conducting with the program developer, Dr. Don Gordon. The webinar is designed for addiction treatment programs’ counselors, administrators, and prevention specialists throughout New Jersey. They will learn how to use the programs’ materials, about the research behind family education, and how to obtain follow-up assistance if needed.

The overall vision is to transform addiction prevention and treatment to include methods that develop well-functioning, healthy family relationships. The continuum of care from prevention to recovery will provide access to information that enhances aspects of treatment, reduces relapse triggers, and supports recovery. I look forward to sharing more with you as the field of parenting and family education unfolds in this new and exciting arena.

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The Wheel is Moving Forward Winter 2015 

Increasing Internship Opportunities for Family Science Students

Efforts to bring lifespan evidence-based family education into societal recognition continues. One goal is to expand opportunities for family science student interns with community service providers, legislators, court systems, home visiting programs, program developers, Cooperative Extension, and school systems. We welcome contact from anyone who has experience placing student interns in these or new professional arenas. We are particularly interested in learning about internship experiences that lead to employment opportunities in settings that previously didn’t have a Family Life Education (FLE) position.

In addition to the expansion of internships we are looking to promote the inclusion of FLE services that are covered by health insurance and offered within employee wellness programs (EWP).  In these situations employees are given reductions in their insurance premium or deductible when attending identified educational programs that improve health and in turn correlate to better job performance. If you know of any employers (public or private) that have included FLE in their EWP, please reach out to me. Further, if you know of Employee Assistance Programs that utilize FLE services (or provide those services), let me know that as well.  And we continue to look for examples where  insurance providers  reimburse FLE as a prevention or early intervention service.

There are several other efforts including synchronizing terms used in FLE with that of international efforts, and, of course, promoting the infusion of family life education in policies so that it becomes the norm and a recognized profession.  To discuss these or additional efforts, feel free to e-mail or call me at ellen@tanerassociates.com or 201-791-3230.

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The Wheel is Moving Forward Summer 2014 

Implications of the Affordable Care Act for Family Life Education

We are gearing up for the third Focused Dialogue to be held on November 19, 2014 from 11:45 am – 1:15 pm at the 76^th NCFR Annual Conference in Baltimore. This year’s focus will be on the scale-up of policies for the infusion of evidence-based parenting and family education. Many national and state representatives will be in attendance with the understanding that they will assist in the follow-up efforts identified during the meeting. Last year, we identified the need for a white paper, and it has been successfully completed and shared with people around the country. If you haven’t yet read Family Life Education: A Profession with a Proven, ROI, be sure to read it. It is posted in the NCFR Professional Resource Library http://www.ncfr.org/professional-resource-library/family-life-education-profession-proven-return-investment-roi .

A big part of the effort of the Focused Dialogue and this column is to inform CFLEs about the Affordable Care Act (ACA) and its implications for family life education. Section 2703 has a primary feature that CFLE’s need to become aware of so that they can advocate for an important role in the formation of these new health service delivery systems. This section of the ACA identifies a dramatic transformation in health service delivery systems operated and supported by counties, including mental health, substance use, and intellectual development/developmental disability (ID/DD) programs. There will be the creation of integrated service systems that combine these separate services into medical homes – operated by primary care entities, or health homes – operated by behavioral health entities. The role of CFLEs in universal, selective or indicated (aka, primary, secondary or tertiary) prevention needs to be defined and designed by our professional workforce as part of the Performance Reforms being identified in these new primary and behavioral healthcare systems. And keep in mind that the ACA includes the elimination of co-pays for health promotion and prevention which removes a key barrier to participation.  

Also Section 1905a of the Social Security Act provides for payment for “other diagnostic, screening, preventive and rehabilitative services including any medical or remedial services (provided in a facility, a home or other setting) recommended by a physician or other licensed practitioner of the healing arts within the scope of their practice under State law, for the maximum reduction of physical or mental disability and restoration of an individual to the best possible function.” We need to identify best strategies to educate for the utilization of CFLEs and referrals to our programs and services.

There is significant progress being made in the country regarding the inclusion of parenting and family education in maternal, infant and early childhood home visitation programs (MIECHVs). CFLEs need to become part of the delivery of evidence-based programs in this setting rather than the overabundant use of nurses, social workers and others. Family life educators are uniquely qualified to provide home visiting services as shared by John Machir in the spring 2014 CFLE Network article, CFLEs as home visitors: Making the case (Vol. 26.2).

Another opportunity for CFLEs exists within funding for Community Health Workers (CHW), another federally recognized initiative used throughout many states. Few Community Health Workers or their supervisors have training in family life education but this is definitely a setting that would benefit from a family life education approach. We are making efforts to address this issue and CFLEs can be a part of this heavy lift.

CFLE’s need to be at the table, or more to the point, we need to bring policy makers and stake holders to the Focused Dialogue table to discuss ways to ensure: the availability of lifespan family education; that all co-parents are able to participate – not only services for maternal and child health; that standards of performance including program fidelity are identified and maintained; and that there is a commitment to a certified professional workforce providing family life education in partnership with other service providers.

And lastly, at the 2013 Focused Dialogue, we were all encouraged to add a tag line, in our own words, to all our correspondence, that informs friends, family, colleagues and others that this profession’s time has come. My business card lists me as a Trainer and Advocate of Family Life Education. Recently I added on the back of the card, “Lifespan family life education is an environmental primary, secondary and tertiary prevention strategy that ensures the provision of evidence-based programs and practices to families at various touch points.” This works for me as an advocate, what works for you?  Let me know at ellen@tanerassociates.com.

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The Wheel is Moving Forward Spring 2014 

Increasing awareness of the role of NCFR and CFLEs in prevention efforts

The advocacy work to promote evidence-based parenting and family education continues to move forward. I continually learn of local, state, national and international efforts to promote the profession and the science of parenting and family education programs as a method to improve the health and well-being of individuals, families, communities and economies.

Recently I attended the Blueprints Conference for Healthy Youth Development and met researchers, practitioners, and national advocates from the United States and abroad. At the keynote session with over 600 in attendance, I asked Mr. Robert Listenbee of the Office of Juvenile Justice and Delinquency Prevention (OJJDP), what strategies the OJJDP was proposing to enable the families of adolescents to break the cycle of criminal and other high-risk behaviors. He gave us all a major opportunity – share our expertise with him and his staff as they are seeking input for a departmental paper due out this September. If you know of specific policies or strategies that have been implemented within an agency or organization toward this effort please forward the information to me at the link below.

Also at the Blueprints Conference I met with people promoting sustainable funding and policies in several federal departments. In follow-up, I learned more about the Centers for Medicare and Medicaid Services regulatory definition of preventive services and the statutory requirements in section 1905(a)(13) of the Social Security Act. Why is that important? Because this opens the possibility for funding through Medicaid billing of a recognized certified workforce for several preventive services including science-informed parenting education. The federal agencies have had difficulty identifying the appropriate workforce and relevant certifications that could be utilized. However, when I mentioned the National Council on Family Relations’ (NCFR) Certified Family Life Educator (CFLE) credential, many in the audience nodded in agreement. I expect to represent NCFR and its professional members’ expertise by participating in a number of in-person and conference-call meetings.  

At the Society for Public Health Education Conference, NCFR Director of Education Dawn Cassidy and I met with many Certified Health Education Specialists and encouraged them to expand their expertise in the domain of parenting and family education by utilizing NCFR’s resources. It is critical that we open ourselves and colleagues to the mission of a developed certified workforce able to identify, provide and sustain funding for evidence-based family life education.

And speaking of colleagues, many NCFR members are also members of the National Parenting Educators Network (NPEN) and read its listserv comments. In case you missed this one though, I encourage you all to take a few moments and read Eve Sullivan’s recent blogpost to the Huffington Post about the Doha International Family Institute conference she attended in Doha, Qatar http://huff.to/1mRZIIS. It’s quite inspiring and remarkable. We all seek to obtain media attention for our profession and programs and reaching the Huffington Post is a great accomplishment. Please share with me any media strategy success you have had that supports the advocacy and implementation of family life education.

The wheel is moving forward – stay in touch with me at ellen@tanerassociates.com.  

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The Wheel is Moving Forward Winter 2014

Four goals identified to make family life education the norm

It is exciting to report that as a result of the Focused Dialogue held at the National Council on Family Relations (NCFR) 75^th Annual Conference in San Antonio last November, we now have a plan for working towards our mission: To create a system supportive of strong healthy families with the premise that lifespan family education improves population health in the present and reduces long-term health care costs. Our vision continues to be that participation in evidence-based family life education programs provided by qualified professionals, is the norm.

We’ve created a logic model for this project (Strong Healthy Families) with four goals:

Goal 1) Create stable funding streams for providers of lifespan family life education.

Goal 2) Identify a body of research and information relevant to the promotion of lifespan evidence-based family life education programs and practices.

Goal 3) Create media strategies promoting the use of evidence-based lifespan family life education programs and skills.

Goal 4) Provide NCFR members and national leaders an opportunity to attend a Focused Dialogue, “Parenting and Family Life Education – The Norm, The Profession” at the NCFR Conference in Baltimore, Maryland in November.

Stable Funding. The first goal will see a continuation of efforts for funding family professionals through insurance billing (both Medicaid and in the newly designed “bundled” healthcare delivery systems identified in the Affordable Care Act) as well as family life education infused into employee wellness programs and resources. A few people have committed to working with their states to explore Medicaid funding, while others are identifying and pursuing small, medium and large-scale employers. An eye remains on the implementation of bundled services and the inclusion of family life education as a leading health promotion and behavioral health prevention strategy.

Identify a Body of Research. A team of NCFR members is working on the second goal by preparing a compilation of research that will be used with accompanying talking points in various advocacy efforts.  More to follow on this herculean effort.

Using the Media. The third goal regarding social and mainstream media is slowly but steadily moving forward. NCFR as an organization and the goal of normalizing family life education is now on the radar of the Hollywood Health and Society organization which has influence in incorporating research-based information into television and movies. We are seeking examples of how family life education and family life education providers are portrayed in local, regional and national media outlets. Please let me know if you see or hear shows that do a good job of incorporating family life education content or that have the potential to do so.

Focused Dialogue Session in Baltimore

The fourth and final goal, a Focused Dialogue session at the 2014 NCFR conference in Baltimore, Maryland, will include national leaders, policy makers, advocates, funders and others who share our commitment to this most worthy and life-enhancing profession. More information about this session will be made available as the year progresses.

Wheels are Moving Forward Blog. We are creating a blog on the NCFR website which will be used to keep everyone apprised of the progress toward our goals. In addition, it will provide an opportunity for feedback and give access to relevant documents and materials so that they can be easily shared. Watch the CFLE listserv for a notice when the blog is available.

Readers interested in more details about any of the above efforts are encouraged to reach out to me at ellen@tanerassociates.com.  I welcome your ideas and resource referrals. 

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The Wheel is Moving Forward Fall 2014 

Third Focused Dialogue Session Brings Continued Opportunity

The National Council on Family Relations’ Annual Conference in Baltimore, Maryland was a huge success. Efforts towards the promotion of family life education as the norm and a recognized profession were continued at the Focused Dialogue (FD) and other meetings. An audience of over 50 observed a guided conversation amongst 15 panelists (with several additional panelists participating over the phone). The panelists represented organizations focused on Extension, the faith community, academia, student internships, parenting education, research, funding and more. Panelists shared interests in policy, the court system, the healthcare system, and promotion of family life education as the norm via the media. Audience members as well as panelists were encouraged to sign up for teams focused on FLE Promotion, FLE in Policies and Professional Partners. These teams will help organize continued efforts including informing and responding to media efforts, student internship and professional opportunities, liaisons with various national and international partners, and additional research.

Some of the innovative ideas presented included advocating for CFLEs in the court system, synchronizing NCFR’s language and terminology with what is used on an international front, collaborating with faith communities’ leaders who are often the first place families turn for assistance when in need, infusing FLE not only with health insurance companies but with life insurance companies, and in promoting FLE in policies not only for billing but in school districts. We look forward to prioritizing the efforts of these teams and having another successful year promoting family life education.

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The Wheel is Moving Forward Summer 2013 

Second Focused Dialogue Session to be held November 6^th in San Antonio

The purpose of this column is to update the members of a most worthy profession, family life education, about efforts to bring lifespan, evidence-based family education into the mainstream. Advocacy efforts have continued since the first NCFR Focused Dialogue, Parenting and Family Life Education – The Profession, The Norm, was held last November. A second Focused Dialogue session is planned for Wednesday, November 6 at the 75^th NCFR Annual Conference. Attendees of the conference in Texas interested in this effort are encouraged to attend.

The original goal of this advocacy work was to bring lifespan, evidence-based family education to the attention of the U. S. Preventive Services Task Force, currently known as the National Prevention Council. The National Prevention Council, created through the Affordable Care Act (ACA), comprises 17 federal departments, agencies and offices and is chaired by the U. S. Surgeon General. The National Prevention Council developed the National Prevention Strategy with input from the Prevention Advisory Group, stakeholders, and the public. For more information, www.surgeongeneral.gov.

The ACA mandates that prevention efforts address behavioral health. The Prevention Advisory Group is ready to begin addressing this mandate. In early July, I had the opportunity to join the Prevention Advisory Group call-in meeting as I had corresponded with the Chairman, Dr. Jeff Levi, also Director of the Trust for America’s Health. Dr. Levi had responded favorably to my advocacy paper’s overarching point – that family education is proven to prevent substance abuse and improve behavioral health and that family life education and qualified family life educators should be included in the ACA as a means to effectively address behavioral health. A sub-committee of the Prevention Advisory Group has been formed to look at behavioral health prevention strategies that will impact families. As the Prevention Advisory Group plans its September meeting and the sub-committee begins to review ideas, we may very well be called upon to provide additional input. The Focused Dialogue may provide an opportunity to address the needs of the Prevention Advisory Group.

Although there is a national advocacy effort, ultimately funding will come down to the state level as each state will determine what is covered by Medicaid. Those that accept Medicaid Expansion, will have greater sources of revenue from the government for the newly enrolled population. The Affordable Care Act fills in current gaps in coverage for the poorest Americans by creating a minimum Medicaid income eligibility level across the country. Beginning in January 2014, individuals under 65 years of age with income below 133 percent of the federal poverty level (FPL) will be eligible for Medicaid. For the first time, low-income adults without children will be guaranteed coverage through Medicaid in every state without need for a waiver, and parents of children will be eligible at a uniform income level across all states. Medicaid and Children’s Health Insurance Program (CHIP) eligibility and enrollment will be much simpler and will be coordinated with the newly created Affordable Insurance Exchanges also known as “marketplaces.”  These marketplaces will offer competitive rates for individuals currently uninsured or who wish to lower their premiums. The overarching goal of the ACA is to ensure that all Americans and legal residents have affordable insurance coverage and access to healthcare services including PREVENTION. 

How does this tie in to family education? Here’s an example:  Currently 60% of hospitals in the US file a 990H form with the IRS to maintain their non-profit status. One of IRS’ requirements is that these hospitals must conduct a Community Health Needs Assessment (CHNA) and once it’s conducted, identify the implementation plan to address the community’s needs. They must also explain which needs they are unable to address and why.

Implementation of the Affordable Care Act has the potential to increase the demand for family life educators. Currently 85% of the hospital‘s profit goes to charity care; payment for medical services provided to those without insurance or Medicaid. Once states, especially those with Medicaid Expansion, increase the numbers of people receiving Medicaid or affordable insurance the need for charity care will be reduced. Hospitals will then be able to allocate profit funds to other needs identified through the CHNA. For example, substance abuse prevention is a common need in most communities. We know from extensive research that evidence-based family education programs prevent substance abuse and other social ills. While hospitals under 990H are not required to be the providers of the services, they may contract with community providers for services, often with agencies and organizations where CFLE’s and other soon-to-be-recognized certified professionals work. 

One more key fact: The new CMS rules allow Medicaid reimbursement for non-licensed professional services. It is important that professionals with the CFLE credential become recognized as key providers of evidence-based family education programs. Family life educators will need to be advocates on national, state and community levels for funding of evidence-based programs. As shared on the NCFR website when describing family life education: the skills and knowledge needed for healthy functioning are widely known: strong communication skills, knowledge of typical human development, good decision-making skills, positive self-esteem, and healthy interpersonal relationships. The goal of family life education is to teach and foster this knowledge and these skills to enable individuals and families to function optimally. As family life education becomes more widely available we will have a healthier society with lower healthcare costs and fewer social ills.

Are you ready to be help move the wheel forward to advance the profession of family life education and reach the goals of the Affordable Care Act?  Join us in San Antonio, TX on November 5^th at the Education and Enrichment Pre-conference workshop to learn more about evidence-based programs and on November 6th at the Focused Dialogue. Feel free to reach out to me ahead of the event at tanerassoc@aol.com subject:  The ACA and Family Education. I look forward to your partnership.  

For more information on this effort visit www.tanerassociates.com.

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The Wheel is Moving Forward Spring 2013 

We Are All Advocates

This column highlights efforts to advance the value and visibility of family life education. One focused effort involves incorporation of FLE into the Affordable Care Act.

I recently had the opportunity to ask Dr. Howard K. Koh, Assistant Secretary of the U.S. Department of Health and Human Services about the relevance of family education in his Department. He remarked that this was an excellent question and referenced the work of the Administration on Children, Youth and Families (ACYF). ACYF administers the major federal programs that support and promote the positive growth and development of children, youth and their families. These programs provide financial assistance to states, community based organizations, and academic institutions to provide services, carry out research and demonstration activities, and undertake training, technical assistance and information dissemination.

I prefaced my question with some key talking points that prove the relevance of family education and stated that it is imperative that it become, “The Norm.” I drew my comments from the following studies. I encourage all family life education professionals to create your own talking points with attention to items that appear in boldface type.

Families are considered to play a key role in health promotion and chronic disease prevention by researchers, legislators, policy-makers, service providers, educators and families themselves.

The Office of Juvenile Justice and Delinquency Prevention has conducted research on the impact of evidence-based family education programs. They found that highly recognized evidence-based programs provide a return of $9.60 per $1.00 invested through the avoidance of alcohol-use disorders alone (Spoth, Guvil and Day 2002). This is very favorable when compared to the return on investment of $5.60 per $1.00 for most prevention efforts.

Social ills such as prison recidivism can be reduced through implemented family education strategies. Mayor Cory Booker of Newark, New Jersey reported a reduction in the prison recidivism rate from an average annual rate of 65% to 6% as a result of a family education program provided.  Note the savings when you consider that each time someone returns to incarceration, the cost is approximately $150,000.

Dr. Vincent Felitti, co-principal investigator of the Kaiser Permanente Adverse Childhood Experiences Study (ACE) stated that family education should be the number one public health priority. As stated by the Centers for Disease Control and Prevention website, “The ACE Study findings suggest that certain childhood experiences are major risk factors for the leading causes of illness and death as well as poor quality of life in the United States. Progress in preventing and recovering from the nation’s worst health and social problems is likely to benefit from understanding that many of these problems arise as a consequence of adverse childhood experiences.”

The Coalition for Whole Health brings together advocates from the mental health and substance use disorder fields for a united force working toward the best care under the Affordable Care Act. They included the advocacy of evidence-based family education as a behavioral health prevention approach in their letter to Vice President Biden in response to the Newtown, Connecticut tragedy.

The Goal of our advocacy effort is to develop a Strategic Framework for a sustainable system for the provision of evidence-based programs and practices for families, with standards of performance, the recognition and training of a competent and available workforce including such professionals as Certified Family Life Educators, Certified Health Education Specialists , Licensed Clinical Social Workers, Certified Prevention Specialists and others, and linkages with social and mainstream media outlets for the societal acceptance of family education and resources.

The Outcome will be a reduction in long-term health care costs which is the overarching goal of the Affordable Care Act. In addition to the prevention of substance use and mental health disorders, and interventions with diabetes and hospice care where family health education has a greater presence, it will expand into the prevention of obesity, stress related diseases, unintended pregnancies, and remediation of adverse childhood experiences. Inclusion of family life education in the Affordable Care Act will reduce other societal ills and costs, and most importantly, it will improve the quality of life for millions of Americans. The public supports investments in prevention and strengthening family health is one area that reaches across all political parties.

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The Wheel is Moving Forward Winter 2013 

The advocacy work to bring lifespan family education to the forefront of the national dialogue continues on many fronts. First, at a recent Forum and Hill Briefing in Washington, DC sponsored by ACMHA – The College for Behavioral Health Leadership, the group heard from Dr. Vincent Felitti, Lead Researcher of the ACE (Adverse Childhood Experiences) Study. When asked his opinion of evidence-based family education used to prevent adverse childhood experiences, he responded that family education should be the number one public health priority. Further efforts by ACMHA and the Council for Whole Health raised family education as a prevention strategy presented to the Vice President’s Task Force developed in response to the Newtown Tragedy.

In addition, a newly formed relationship with the National Association for Children of Alcoholics has resulted in the design of a collaborative project that is seeking funding from the Centers for Disease Control. As with the Focused Dialogue session held last November at the NCFR Conference in Phoenix, the goal is Family Life Education. The Profession, the Norm. (Network, Vol. 24.4). If funding is received strategies will be implemented to upscale public health’s capacity building of an infrastructure that addresses our goal. CFLE’s will play a significant role in the workforce needed to research and implement programs, policies, and regulations that enhance targeted outcomes and remove obstacles to the achievement of program goals.

 NCFR is gearing up for the next national conference November 6-9 in San Antonio, Texas. An expanded Focused Dialogue is being designed to build upon last years’ work where we identified different paths or “hubs” including The Affordable Care Act, Research, Funding Sources, Policy Making, Technology/Media, and Partner. Each hub of the wheel will have its own ninety minute dialogue and then the groups will reconvene for a reporting out of those dialogues. A compilation of ideas for further action will result and committed partners will emerge. The next issue of Network will elaborate on this effort.

Also, we will be making a concerted effort to recruit evidence-based programs to exhibit at the NCFR Conference. This will enable CFLE’s and other practitioners to meet face-to-face  and to learn about each other. A panel is also being designed that will feature topics related to evidence-based programs research, national registries, returns on investment, funding sources, and more. We’ll be sharing information on this via the CFLE listserv and the NCFR website so stay tuned.

Readers interested in more details about any of the above efforts are encouraged to reach out to me at tanerassoc@gmail.com subject:  The Wheel is Moving Forward. I welcome your ideas and resource referrals.

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The Wheel is Moving Forward Fall 2013 

Advocating for Evidence-based Lifespan Parenting and Education

As of this writing, we are in the final stage of preparing for the 75^th NCFR Annual Conference. It is exciting that we have several people confirmed to participate in the second Focused Dialogue who combined, bring various components of the needed expertise for this national, state, local and professional advocacy for parenting and family education to become the norm and a recognized profession.

Each of us, whether we attend this conference or dialogue, have a role in this advocacy in whatever way works for us. The challenge is big, yet no challenge starts at the end – it starts with one step and continues with a next and a next with a faith in the purpose that will allow us to be guided along the way. Each of us must ask ourselves, daily, “What difference can I make?”  Within ourselves is the answer, however, it requires that we silence the noise around us and listen for that inner voice that will guide us to the next step. As new age as this sounds, (or ancient if you read the Tao Te Ching), this requires a balance of doing and not doing.

Although I have been a parenting and family educator for over three decades, two and half years ago I declared my commitment to this advocacy with a statement – My purpose in life is to have loving families throughout the world. That was my first step, then I took another, and then another. I met amazing people at NCFR. We conducted the first Focused Dialogue last year. More steps and in September, just prior to the Federal Shutdown, I found myself in Washington, D.C. meeting with members of the Coalition for Whole Health (a nationally recognized and leading advocacy and advisory group for behavioral health issues) and leaders of the Substance Abuse and Mental Health Systems Administration (SAMHSA), Centers for Medicare and Medicaid Services (CMS) and The Center for Consumer Information and Insurance Oversight (CCIIO).

Now some of you reading this have far more experience working on a national level, but for me, this was not on my radar two years ago. It happened, and will continue to happen, because of the daily steps I take as an individual and with others who continue to support and inspire me. As a community of future and current professionals, our individual and collective actions will have an impact. Pause from your daily responsibilities and think of what your commitment is to this profession and the people you serve. Listen to what bubbles up, write it down and post it where you can see it, declare it, and take a step and then another. Silence those thoughts that inhibit you such as, “My plate is already full,” “I don’t know how,” or any other thing that minimizes the contribution you can and do make. Remember, the goal of family life education is to teach and foster knowledge and skills to enable individuals and families to function optimally. We know that we can improve the health of this country and reduce healthcare costs by making parenting and family education the norm.

I want to hear from you about how your advocacy is going. Did you speak with a local MD sharing your ideas about how her/his practice can include parenting and family education?  Did you meet with an elected official and plant the seeds for them to consider ways he/she can infuse parenting and family education in their policies? Did you decide to expand your knowledge of evidence-based programs and register to become trained in a curriculum or complete an on-line program to increase your knowledge of the skills taught in these programs? The list of things you can do is endless – but one thing is certain, each of us has a voice to be heard that will move the Wheel Forward. E-mail me at tanerassoc@aol.com

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The Wheel is Moving Forward Fall 2012 

FLE From Womb to Tomb 

On November 1, 12 participants, 28 audience members and 2 Skypers participated in a Focused Dialogue, Parenting and Family Life Education and the Affordable Care Act, designed and facilitated by Ellen Taner of Taner Associates. Ms. Taner has a strong background in public health and has been a parenting and family educator and trainer of several evidenced-based published programs for over three decades.  She is also trained in The Dialogue for Community Health and used these techniques in the design and implementation of the Focused Dialogue.

A wheel image was used to represent the concept. The hub of the wheel made up the core central theme: Parenting and Family Life Education – the Profession, the Norm. From that hub the spokes lead to the following topics: The Affordable Care Act, Research, Funding Sources, Policy Making, Technology/Media and Partners. Ten to fifteen minutes were devoted to each topic followed by a concluding section: Where do we go from here?”

The overwhelming majority of the group agreed that we all need to learn more about the contents of the four pillars of healthcare reform which include Insurance Reform, Coverage Expansion, Delivery System Redesign and Payment Reform. Clearly, this one spoke of the wheel could have monopolized the entire discussion so people were encouraged to research any of the following websites and organizations for additional information: www.HealthCare.gov, www.HealthReform.gov, www.HealthCareandYou.org, www.ConsumerReports.org, the American Public Health Association (www.apha.org), Partnership for Prevention (www.prevent.org), and the Commonwealth Fund, (www.commonwealthfunding.org), a private foundation that promotes the research associated with the implementation of the ACA.

During the Research section of the discussion, the Adverse Childhood Experiences (ACE) study was referenced. The ACE study provides significant research of interest to insurance companies as it makes clear that adverse childhood experiences are leading contributors to the nation’s worst health and social problems. Prevention of such experiences will result in significant savings. The cost effectiveness of evidence-based parenting education programs was discussed. For example, research on the Strengthening Families Program for parents and youth 10-14 shows that for every dollar ($1) a community spends on the program, it saves $9.60. Other research of interest to legislators and policy makers was discussed as well.

Under the Funding Sources section, resources were discussed for parenting and family life education such as Employee Assistance Programs (EAP’s), Employee Family Resources (EFR’s,) Employee Wellness Programs, Medicaid, Private Payers, Grants, and of course, insurance companies. When discussing Policy-Making Audiences, it was noted that business owners, legislators, and lobbyists are increasingly interested in efforts that affect their bottom line and that the weaving of parenting and family education into those topics is an appropriate approach. It was also posed that if we have two or three states that have already tested out policies regarding funding of parent and family education, it would be helpful to report this information to other states.

A very lively discussion ensued when Technology/Media was considered including the suggestion that having characters on mainstream television shows attend parenting education would go a long way to promote the concept. One participant immediately began texting a friend at a major television network in charge of programming to raise this issue. Another participant highly recommended looking into the work of First Things First www.firstthingsfirst.org. They developed messages on billboards, bus and train plaques, etc. as a way to meet the goals of lowering non-marital pregnancies, show the importance of fathers, and lower divorce rates. Funding for these efforts came from the business community in Chattanooga, TN. Several foundations were mentioned that also address violence prevention, a tangential issue to parenting and family life education. And when discussing Partners, a key focus was on the faith community and their role in promoting, hosting and funding parenting and family life education.

Audience members added significantly to the dialogue. The final check-out regarding what people were taking away from the dialogue that calls them to action was very inspiring. Updates will be forthcoming in the next issue. For more information on this issue including the Focused Dialogue agenda, and supporting materials, please visit, www.tanerassociates.com, under the tab, Focused Dialogue. Information will also appear on the NCFR website under CFLE News.

Facilitating this focused dialogue will utilize methods of “Dialogue in Community Health” (DCH) developed by Cross River Connections.  DCH was a project supported under a cooperative agreement from the Centers for Disease Control and Prevention through the National Association of County and City Health Officials in 2003.   Ellen Taner became a trained facilitator by Dr. Daniel Martin, author of  the dialogue training  manual that was built upon his collaboration with the Interaction Institute for Social Change, Cambridge, MA.

The goal of this focused dialogue is for invitees to provide knowledge in their area of expertise towards the ultimate vision of having parenting and family education a nationally recognized funded profession through insurance providers, Medicaid, workplace wellness programs and other sources beyond the current system of grants.  Upon completion of this focused dialogue, all participants will be invited to continue to update the website about their direct role in the promotion of evidence based programs and practices of the parenting and family life education profession.  Additional collective dialogues including telecommunications and in-person sessions will be arranged.

As the profession grows, so too will the societal norm of participation in parenting and family life education from “womb to tomb”.  This will have a significant impact on the promotion of health including but not limited to substance abuse prevention, early intervention and recovery support; reduction of criminal behavior and recidivism; promotion of healthy nutrition and physical activity;  relationship skill-building to reduce bullying,  domestic violence and divorce; improve employee performance; and  increase achievement of youth and family goals.