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��•~
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THE WHITE HOUSE
OFFICE OF DOMESTIC POLICY
CAROl H. RASCO
Assistant to the President for Domestic Policy
To:
Draft response for POTUS
and forward to CHR b y : - - - - - - - - - ' - - - - - - - - Draft response for CHR by: - - - - - - - - - - - - - - - - Please reply directly to the writer
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�APR I 4 REC'D
~
~
JOINT
CENTER
-FORPOLITICAL
AND ECONOMIC
STUDIES
PRESIDENT
April 12, 1994
Carol Rasco
Assistant to the President, Domestic Policy
The White House
1600 Pennsylvania Avenue, N.W.
Washington, D.C. 20500
Dear Ms. Rasco:
The Joint Center for Political and Economic Studies and the Johns Hopkins University School of
Public Health cordially invite you to participate in their conference on "Health Care Needs of Hispanics
and African Americans: Policy Issues and Challenges" on Thursday, May 26, 1994. The conference will
be at the Grand Hyatt Hotel (1000 H Street, N.W., Washington, D.C.) and will feature working sessions
from 8:30am to 5:00pm.
Dr. Robert Valdez, Deputy Assistant Secretary for Interagency Policy (Designate) at the U.S.
Department of Health and Human Services, will be our luncheon speaker.
The conference will report findings of a study of barriers to health care for the black and Hispanic
populations using the 1987 National Medical Expenditure Survey. The research was conducted under the
direction of Dr. Marsha Lillie-Blanton of Johns Hopkins. The morning sessions will examine barriers to
care for the Hispanic and African American populations, and the afternoon sessions will focus on health
care policy issues related to these barriers. Both the research and conference are supported by a grant from
The Commonwealth Fund.
We are confident you will tind the conference timely and informative, and we hope that you will
be able to attend.
Please let us know at your earliest convenience (but no later than Friday, May 13, 1994) if you will
be able to attend the conference by completing and returning the enclosed form by FAX (202-789-6390).
Sincerely,
~ ~-UJde~
Eddie N. Williams
1090 Vermont Avenue, NW • Suite llOO • Washington, D.C. 20005-4961 • 202-789-3500 • Fax 202-789-6388
A Nonprofit, Tax-exempt Institution
�:>-
~
JOINT
CENTER-
-FoR-.POLITICAL
AND ECONOMIC
STUDIES
TO:
Elecia Johnson
FROM:
c . f1LLAd..
~
SUBJECT: Conference on "Health Care Need~ of Hispanic and African
Americans: Policy Issues and Challenges" (May 26, 1994)
Please mark the appropriate line(s) below.
I will attend the conference sessions (May 26, 1994) _
I will attend the conference and luncheon (May 26, 1994)
_0 will be unable to attend the conference (May 26, 1994)
Return this form by ·FAX (202-789-6390) before Friday, May 13, 1994. Thank
·you.
1090 Vennont Avenue, NW • Suite llOO • Washington, D.C. 20005-4961 • 202-789-3500 • Fax 202-789-6390
A Nonprofit, Tax-exempt Institution
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THE WHITE HOUSE
OFFICE OF DOMESTIC POLICY
·CAROL H. RASCO
Assistant to the President for Domestic Policy
To:
Draft response for POTUS
and forward to CHR b y : - - - - - - - - - - - - - - - -
?-?
Draft response for CHR by: -------------..-~.---+--Please reply directly to the writer
(copy to CHR) by: -----------~~d-__]L_ __
_
Please advise by: _ _ _ _ _ _ _ _ _ _ _ _ _~----Let's discuss: - - - - - - - - - - - - - - - - - - - - For your i n f o r m a t i o n : - - - - - - - - - - - - - - - - - Reply using form code: _ _ _ _ _ _ _ _ _ _ _ _- ' - - - - - - 1
File: - - - - - - - - - - - - - - - - - ' - - - ' - - - - - + - Send copy to (original to CHR): _ _ _ _ _ _ _ _ ____,~~~-Schedule?:
OAccept
0 Pending
�'·
'
The
Center
for
APR I 3 REC'O
Public
Jus!i£~~
Washington, D.C. 20002-0368
(202) 546-0489
1835 HForest Drive
Annapolis, MD 21401
(410) 263-5909
fax (410) 263-3857
April 8, 1994
Carol Rasco
Assistant to the President for Domestic Policy
The White House
1600 Pennsylvania Ave., N.W.
Washington, D.C. 20500
Dear Ms. Rasco:
I am grateful to Elizabeth Rule for contacting you in support of our
invitation to President Clinton to address our conference "Public
Justice and Welfare Reform" on·-··----~ at the Sheraton Crystal
May 19 or 20
City Hotel. (For your information I am enclosing a copy of the
original invitation to the President, dated January 28.)
As the date of the conference draws near, its timing appears to be
increasingly propitious for a presidential address.
My purpose in writing again at this point is to send you a copy of
the formal :'!summary" of the 50-page-,essay that will be released to
,the public at 4:00 p.m. on the 19th.- As soon as the larger document
comes off the press, I' 11 immediately send a copy to you for the
President. Both this summary and the larger document should be
self-explanatory, but I would be more than willing to give you
and/or a member of your staff a personal briefing on it, on the
larger project, and on the purposes of our upcoming conference, if
that would be of use to you.
Because of the excellent timing of the conference, we are receiving
far more inquiries and registrations from around the country than we
anticipated. We have invited a number of mayors, state officials,
and members of Congress to participate, beginning with an opening
news conference at 4:00 p.m. on the 19th. We do hope the President
will be able to speak sometime on either the 19th or 20th.
Thank you very much for your consideration. Please let me know if
there is anything further I can do to be of help in this regard.
incerely,
~v___.LJ~
James 1 W. Skillen
Executive Director
JWS/awp
enclosures
copies:
William Galston, Deputy Assistant to the President for
- Domestic Policy
Elizabeth Rule, Senior Staff Specialist, USIA
�Summary of
A New Vision for Welfare Reform
An Essay in Draft
Stanley W. Carlson-Thies
and
James W. Skillen
for
The Welfare Responsibility Project Team
Welfare Responsibility
An Inquiry into the Roots of America's Welfare Policy Crisis
A Project of
The Center for Public Justice
Washington, D.C.
1994
�©The Center for Public Justice, March 1994
The full text of this essay will be released on May 19, 1994, at the start of the national
conference on Public Justice and Welfare Reform, which will be held on 19-20 May 1994, at the
Sheraton Crystal City Hotel, Arlington, Virginia.
That text will be a draft text. A final, revised version will be published in 1995. Critical
comments and suggestions in response to this summary of the draft text are invited. ,
The Center for Public Justice
P. 0. Box 48368
Washington; DC 20002-0368
410-263-5909
410-263-3857 (fax)
�Sununary of
A NEW VISION FOR WELFARE REFORM
Introduction
American welfare policy stands at an impasse. Despite decades of intense anti-poverty
campaigns, poverty persists. In many inner cities, welfare dependency appears to be
entrenched and at the center of a web of dysfunctional social conditions. Most Americans want
to help people in need, but few are satisfied any longer with government programs to assist the
poor. Many now believe that welfare programs do more harm than good.
A variety of reforms have been proposed in recent years to reverse the failures and to
overcome growing skepticism about government policy making. But a new consensus has not
yet been reached. Instead, an often debilitating polarization has emerged. One side urges
government to do more for the poor, while the other side presses for an end to the welfare
,
__
system altogether.
Part of the problem, we believe, is government's continuing preoccupation with a narrowly
economic interpretation of poverty. The poorest of the poor lack more than economic resources.
Many are demoralized; many are either ill-equipped or unwilling to fulfill their responsibilities.
Typically, they are surrounded by social and moral decay. Current welfare programs are not
the sole cause of their distress, and better welfare programs will not provide the entire solution.
In order to break the policy impasse and to deal constructively with the growing poverty
crisis-especially in our inner cities-Americans need a new approach organized around a
better understanding of human nature and society. We need a new vision of a just society-of
how human responsibility should be exercised, not only by governments, but also by families,
schools, churches, businesses, and service organizations.
The argument of" A New Vision for Welfare Reform" is built on four propositions.
·.,
Welfare Policy in a Bind
THESIS I: Fruitful welfare reform depends on an accurate understanding of human dignity
and the nature of diverse human vocations and obligations. American politics is hampered by
problematic assumptions and patterns that all too often push aside important aspects of the
truth about human life in a complex society in a rapidly shrinking world.
The prevailing climate of American public life can be characterized in these terms:
1
�2
A. Americans generally believe that individuals ought to be as free as possible from imposed
obligations in order to be able to pursue their interests and to choose their own means of
self-realization.
B. Public policies are typically built on the assumption that human beings are self-interested
individuals whose socially important actions should be channeled by means of material
incentives and penalties that play to that self-interest.
C. Politicians act on the assumption that the economic marketplace is the primary public arena
of self-determination and self-realization. Self-interested pursuits are supposed to lead
both to individual happiness and to the greater social good.
D. Government's chief responsibility, in this framework, is to protect citizens in their civil rights
and their pursuit of happiness while it promotes the greater good by means of economic
growth.
E. Most citizens believe that government should do something to assist the poor who do not
. benefit from the nation's econo!lllc progress or who may be suffering negative consequences
fromit.
Welfare policies do not stand alone. They ar~ embedded in a larger political and
economic context. Debates over welfare, therefore, are bound up with controversies about the
task of government, about the nature and purpose of a market economy, and about human
nature itself.
In our estimation, the prevailing climate of American politics cannot resolve the dilemmas
that now stymie the debate o·ver welfare. Consider this question, for example: Are individuals
poor because they have not diligently used their freedom to succeed in the market? Or, to the
'·,
contrary, are individuals poor because of social and economic forces beyond their control?
At issue is how to justify welfare programs. Should government reinforce market rules
rather than give assistance to poor people, so that economic incentives and penalties can.teach
people how to succeed on their own? Or, to the contrary, should government give special help
to the poor as a means of correcting market forces that have produced unjust outcomes?
This seemingly unresolvable dilemma is due, we believe, to a mistaken understanding of
human life in society. The poverty-and-welfare crisis does not consist merely of too many
people condemned to low incomes either because they have not played by market rules or
because they have not received enough benefits from government. To assess the true nature of
the crisis, we need a vision that can overcome the false dilemmas of freedom vs. determinism, of
individual self-sufficiency vs. public dependency.
�3
In Search of a Better Worldview
THESIS II: A dependable vision of human life in society comes most clearly into focus from a
biblical point of view. Human beings are created in God's image with many talents and
vocations. Every task, including government's calling to do justice, has the character of a
response to the Creator. God's love for this world, which is now radically marred by evil, is
being revealed in ways that expose our sin and misery and offer healing for our brokenness.
With this thesis, a framework of thought and action comes into view that contrasts
sharply with the assumptions and patterns dominant in our political culture.
A. From a biblical point of view, human beings have the high dignity of being created in God's
image, serving as God's stewards, and bearing moral responsibility for one another
according to standards not devised by themselves.
B. Creativity and the ability to make decisions are part and parcel of our human moral
character, which cannot be reduced to a biological or environmental determinism.
C. The market, which is increasingly international in s<;:ope, is but one among many arenas of
social exchange, and it entails its own moral obligations, such as honesty, careful
management, and wise stewardship of human and natural resources.
D. A biblical view emphasizes government's calling to establish and uphold justice for societies
in which people bear many different kinds of responsibility for one another.
E. Governments should pursue fundamental reforms where patterns of injustice exist, revising
public laws and policies wherever they inhibit responsible action or encourage irresponsible
action on the part of individuals, corporations, families, schools, churches, voluntary
organizations, and the government itself.
Human beings bear the high dignity of being created in God's image. The quality of our
human actions is neither reducible to genetic and social conditions nor expressive of complete
autonomy and self-determination. Humans are capable of acting and of making judgments
about human cultural and social realities because they have been created to respond to the
Creator's will for human life. Human freedom is a freedom in response to God. God's
commands to work, to do justice, to love our neighbors, to honor parents, to care for all of
creation are mandates that constitute human life and orient it toward its true meaning.
But people are capable of dishonoring these commands, of perpetrating injustice, of hating
and killing their neighbors. They can misuse other creatures, become indolent, and turn their
backs on the Creator. Humans are morally responsible creatures.
�4
Policy making should take seriously the fact that human beings hold marty different kinds
of responsibility and are morally accountable when they fail to fulfill them. Precisely because
government does. not have total responsibilityfor life in a differentiated society, its policies
should clearly acknowledge the obligations and culpabilities of others. In not expecting
government to function as the spouse, parent, teacher, employer, and ultimate savior of the
needy, we nonetheless dQ. expect it to fulfill its own calling to establish justice and fight injustice
so that spouses, parents, teachers, employers, and various ministries of mercy can better fulfill
their roles in various accountability structures.
A biblical unqerstanding of life gives hope for renewal and reconciliation, not on the basis
of self-designed programs of salvation, but because of God's initiative to overcome evil and to
redeem the world. In the strength of this hope we can then turn with renewed energy to the
respons~bilities
God has given us in all areas of life. We will, among other things, call
government to do more than simply translate interest-group pressures into law. We will call it
to do justice and to fight without compromise against injustice.
A Responsibility Crisis
THESIS III: The distressing conditions associated with poverty, particularly in the most
degraded urban areas, are the expression of a multifaceted responsibility crisis. These tragic
conditions cannot be measured by poverty statistics alone, for they represent the moral fail!-lres of .
social institutions, governments, and individuals.
If we are correct that the most severe conditions of poverty today are the consequence of
multiple human errors and failures, then any proposed "solution" to this crisis will have to offer
more than either better or fewer welfare programs. We must consider real people who bear
diverse responsibilities-people and institutions who in various ways need to accept and fulfill
their obligations. The poverty crisis is not narrowly a problem of supplying more income to
individuals defined statistically as being poor. The problems associated with poverty call us to
a reconsideration of government's welfare policies, but they call us to more than that.
Government's responsibility in a complex and differentiated society can never be exclusive
or exhaustive. The sources and contexts of a healthy life are families, friendships, schooling,
apprenticeships, work, communities of faith; and more. Welfare policies should aim to restore
people to responsibility in healthy relationships and organiZations instead of aiming to lift
individuals out of poverty by making them the direct clients of government.
Our distorted welfare system, which all too often treats individuals abstractly as poor
people dependent on government, overlooks the fact that a variety of vocations and obligations
need to be fulfilled simultaneously in the intricate web of a complex society. If people's lives
�-...
..
5
are to be healthy, parents need to care for their children, teachers need to educate students,
employers need to provide jobs, all at the same time. No single responsibility can be ignored or
discounted. The teacher may not pass along a failing student with the excuse that the student's
home life is poor and that nothing more can be expected. An absent father may not be excused
for abandoning his children and their mother on the grounds that jobs are scarce. Local
governments may not be excused for failing to restrain urban violence on the grounds that too
many families and schools have broken down. Every person and institution must be held
accountable to fulfill their obligations to the utmost possible; none can be excused or
discounted.
To Do Justice
THESIS ,IV: Governments are called to establish and enforce public justice by (a) upholding a
just sodal order, (b) assisting with relief in emergencies, and (c) acting to bring about
fundamental reforms where patterns of injustice exist. Public policies should not serve to
legitimize irresponsibility. Instead, government should call people and institutions to healthy
patterns of life in society.
A. Government's first responsibility is to uphold a just social order by protecting and
encouraging citizens to fulfill both their civic and their non-civi~ responsibilities. Through its
standard operating policies government maintains the necessary infrastructure, such as roads,
water systems, police forces, fire protection, and a financial system. It funds education and, by
means of tax policies and other programs, spreads out the burdens of the commonwealth in an
equitable fashion, assuring the fair treatment of every citiz~n.
1. Thus, for example, government should uphold the parental covenant by requiring
fathers as well as mothers to fulfill their obligations to their children. If government cannot or
will not back up the parental covenant, then welfare policy will inevitably fail. If welfare policy
tries to compensate for parental irresponsibility, while allowing that irresponsibility to continue,
it will not be able to save children from the dire consequences of parental failures.
2. Government should also act in support of families and others who care for
dependents. It should, for example, increase the standard income-tax deduction for
dependents, linking it with a correspondingly large increase in the earned income tax credit for
those who are working but not earning enough to support their families. This would be the right
way to encourage parents both in their work and in the fulfillment of their family vocations.
B. A second mode of government responsibility is that of emergency relief. When the
police race to an accident, or when unemployment insurance temporarily sustains a laid-off
worker, an immediate problem is kept from growing into a long-term crisis. Emergency relief
1,
�6
works because the people and institutions affected by the disaster are capable of fulfilling their
normal responsibilities as soon as the disaster is overcome.
1. In a similar fashion, a program of universal insurance coverage against the catastrophic
.
.
costs of health care can be justified as a shield against- a health emergency becoming a long-term
and multiplying social crisis.
2. Some urban areas are filled with violence, as gangs and the drug trade overwhelm the
police. It is not right for responsible people to have to go about their work, rear their children,
and try to pursue the ordinary duties of life while living in war zones. In these cases,
governments have failed to fulfill their obligation to uphold the good order of society. If such
circumstances represent a state of emergency, then emergency measures may now be required.
3. On the other side, some government programs designed to meet emergencies may
unintenti<?nally give ongoing support to irresponsibility rather than temporary relief. AFDC's
checks help many women escape financial disaster, but in other cases they support
irresponsible patterns of nonwork and child bearing outside of marriage. Such government
policies need to be redesigned to help people in emergencies by restoring them to healthy
patterns of accountability.
C. A third mode of government action might be described as long-term regenerative
reform that seeks to overcome structural patterns of injustice. Here government aims to bring
about a system change in a complex network of interdependent responsibilities.
1. One example of such reform would be a new health insurance system. The current · ·
Medicaid program for the poor exemplifies the dilemma created by the dominant assumptions
and patterns of American politics. Rather than address the causes of poverty and the systemic
deficiencies of our current welter of health insurance programs, government has taken a reactive
stance, offering through Medicaid inadequate health-care services to people after they have
become impoverished. A major system reform of health insurance is needed to ensure universal
coverage. This obviously entails significant changes in the interdependent responsibilities of
health insurance companies, hospitals, doctors, employers, families, and many departments of
government.
2. Another example concerns educational reform. Here there is need for a change in the
system of interconnected responsibilities among families, schools, governments, and the
workplace. Two institutions that bear heavy responsibility for human maturation are the family
and the school. Long-term reform must, therefore, seek to strengthen both of these institutions
and to promote close cooperation between them. Government support of a free education for
every child is, we believe, a sound standard operating policy. But the means of distributing that
support should be changed to make it possible for all parents to exercise more responsibility for
their children's education without financial or religious discrimination.
�,.,.
6
works because the people and institutiqns affected by the disaster are capable of fulfilling their
normal responsibilities as soon as the disaster is overcome.
1. In a similar fashion, a program of universal insurance coverage against the catastrophic
costs of health care can be justified as a shield against a health emergency becoming a long-term
and multiplying social crisis.
2. Some urban areas are filled with violence, as gangs and the drug trade overwhelm the
police. It is not right for responsible people to have to go about their work, rear their children,
and try to pursue the ordinary duties of life while living in war zones. In these cases,
governments have failed to fulfill their obligation to uphold the good order of society. If such
circumstances represent a state of emergency, then emergency measures may now be required.
3. On the other side, some government programs designed to meet emergencies may
unintenticmally give ongoing support to irresponsibility rather than temporary relief. AFDC' s
checks help many women escape financial disaster, but in other cases they support
irresponsible patterns of nonwork and child bearing outside of marriage. Such government
policies need to be redesigned to help people in emergencies by restoring them to healthy
patterns of accountability.
C. A third mode of government action might be described as long-term regenerative
reform that seekS to overcome structural patterns of injustice. Here government aims to bring
about a system change in a complex network of interdependent responsibilities.
1. One example of such reform would be a new health insurance system. The current · ·
Medicaid program for the poor exemplifies the dilemma created by the dominant assumptions ·
and patterns of American politics. Rather than address the causes of poverty and the systemic
deficiencies of our current welter of health insurance programs, government has taken a reactive
stance, offering through Medicaid inadequate health-care services to people after they have
become impoverished. A major system reform of health insurance is needed to ensure universal
coverage. This obviously entails significant changes in the interdependent responsibilities of
health insurance companies, hospitals, doctors, employers, families, and many departments of
government.
2. Another example concerns educational reform. Here there is need for a change in the
system of interconnected responsibilities among families, schools, governments, and the
workplace .. Two institutionS that bear heavy responsibility for human maturation are the family
and the school. Long-term reform must, therefore, seek to strengthen both of these institutions
and to promote close cooperation between them. Government support of a free education for
every child is, we believe, a sound standard operating policy. But the means of distributing that
support should be changed to make it possible for all parents to exercise more responsibility for
their children's education without financial or religious discrimination.
�7
The poorest Americans now have very little opportunity to guide their children's
education. They do not have the means to buy a house in a good school district or to pay
tuition at an independent school. Even the most responsible parents are trapped, forced by
government's own laws to submit their children to a process that in some cases amounts to
outright miseducation. Reform should make it possible for all parents to exercise real
responsibility in choosing schools for their children, having at their disposal a fair share of
education dollars.
3. A third fundamental reform is to halt all discrimination in law against religious
organizations that serve the poor. There is no legitimate reason why government should ignore
or constrain groups whose assistance is inspired by religious convictions. When it comes to
reclaiming devastated lives and communities, self-professed religious organizations often prove
to be the most important and valuable contributors to reform. Therefore, insofar as government
authorizes funding for education, job training, counseling, adoption, rehabilitation, food for the
hungry, shelter for the homeless, or any number of other services, it should revise its laws and
programs to channel funds proportionately to all effective independent institutions and
agencies that deliver those services.
Conclusion
We have argued that the reform of welfare policy appears to be stymied because it is
caught on the horns of dilemmas fostered by a faulty vision of human responsibility. Trying, by
contrast, to take seriously the implications of a biblical worldview, we have exposed a
multifaceted responsibility crisis, which is often overlooked by those who focus their attention
on the problem of low incomes. To address the responsibility crisis, it will be necessary for
governments to change their mode of operation from one of taking on clients to one of
strengthening the multiple accountability structures in society. Government should do its part
by fulfilling its own obligations to uphold justice in society, to respond to emergencies, and to
work for the fundamental reform of unjust social patterns.
�-C'
Of course welfare as
we know it must end.
But why did we create
such a system
.in the first place?
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WELFARE
REFORM
--- --~-need-a-n-ew-vision-
ofjustice that promotes
responsible action.
Washington,· D. C.
May 19-20, 1994
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�AN INVITATION
·nESPITE DECADES of government programs, poverty persists
and is growing in America. Even more
tragically, in many of our inner cities
poverty and dependence on government support seem to have become
endemic and wedded to severe personal and social dysfunctions.
The public is feq up. Experts on poverty and welfare policy are polarized.
The religious community, too, is
divided about what to do.
The goal of the conference is to move
the debate forward by critical discussion of a proposed conception of public
justice in a differentiated society.
The conference hosts believe that a
biblical view of human responsibility,
of the plural structure of society, and of
the limited but positive tasks of government offers a dependable orientation
for the rethinking of welfare policy.
Whatever your point of view, we invite
you to participate in a serious conversation about these critical issues of ·
government policy, personal responsibility, and social justice.
Conference Format
Conference Agenda
··THE
CONFERENCE is organized around a series
-•··.· . of basic theses about human nature, the differen-. ~tiated structure of society, and the diverse responsi, :.bilities of .persons, government, and social institutions.
·'.::.:· Invited~~i:J.ell.sts will debate the theses. There will be
time for questions from the floor and discussion at the
end of each session. The panel debates will have a significant impact on the shape of the project's final
·recommendations and publications.
Conference registrants will receive in advance the
draft statement that outlines the project team's argument for a distinctive approach to the reform of welfare policy. Registrants will also receive in advance
the synopses of background papers commissioned for
the conference. The papers themselves will be available for purchase at the conference.
THURSDAY
5:00pm
Reception
7:00pm
A New Vision for Welfare Policy
Keynote address with responses
FRIDAY
8:30am
Session 1: Building a New Foundation for
Welfare Policy
Panel debate and open forum
ll:OOam
Session II: Reorienting the Debate: The
Revival of Responsibility
Panel debate and open forum
1:OOpm
Lunch
2:00pm
Session ill: Differentiated Responsibilities:
Persons, Society, and Government
Panel debate and open forum
4:30pm
Session IV: Fulfilling Diverse Responsibilities: Policy Consequences
Panel debate and open forum
7:30pm
Banquet
Conference Sponsorship
HIS EVENT is the public highlight of a three-year
Inquiry-now at midpoint-into the roots of
America's welfare policy crisis. The project is being
conducted by the Center for Public Justice, which is
dedicated to public policy research and civic education oriented by a biblical view of life. Among the
Center's other major interests are the reform of education policy, electoral and political reform, and the
development of Christian democratic movements
around the world.
T
Recent Center-related publications include The School
Choice Controversy: What Is Constitutional? (J. Skil. len, ed., 1993); Christianity & Democracy in Global
Context (J. Witte, Jr., ed., 1993); and Political Order
and the Plural Structure of Society (J. Skillen and R.
McCarthy, eds., 1991).
The Welfare Responsibility Inquiry, including this conference, is conducted in cooperation with the Christian
College Coalition. It is supported by a grant from The
Pew Charitable Trusts.
A Challenge to Mutual Accountability
Closing Address
�----------------------------------.
~
...,,.,
, / TI1e
Center
forPu}.llic
.J ce
ustt
Welfare Responsibility
Anlnqmry into tlre
H~ of America's Welfare Policy Crisis
I~ 0. Box 48368
Washington, D.C. 20002-0368
(202) 546-0489
January 28 , 1994
1835 II Forest Drive
Annapolis, MD 21401
(410) 263-5909
fax (410) 263-3857
President Bill Clinton
The White House
1600 Pennsylvania .Ave., N.W.
Washington, D.C. 20500
Dear Mr. President:
With this letter I am pleased to be able to invite you to speak
at our upcoming conference on "Public Justice and Welfare Reform"
here in Washington on May 19-20. It is described in the enclosed
brochure.
In your State of the Union address earlier this week you argued
for refonns that are quite congruent with many of our aims: "If
we value strong families," you said, "we can't perpetuate a
system that actually penalizes those who stay together." And
again: "The people who most want to change this system are the
people who are dependent on it."
Your
more
care
that
support of an increase in the earned income tax credit, of
radical reforms of education and job training, and of health
insurance for all citizens are the kinds of system changes
we also believe are necessary.
However, as you suggested at several ptiints in your speech, the
issue of welfare reform has to do with more than devising a
variety of government policy reforms. It has to do with gaining
a new vision of a just society and building a new consensus among
the American public with regard to the responsibilities people
bear in different capacities. What is government's proper role
in distinction from (and in relation to) the responsibilities
people bear as parents, teachers, employers, employees, church
members, and in other capacities?
These underlying questions are the ones on which we will focus
attention at the May 19-20 conference, and we would be honored if
you would come to address us then.
AResearch Project ConductL>tlllnder the Auspices of the Chrbti<UI wllege Ox~ ilion
�·..
President Clinton
Page 2
The conference represents the high point of a three-year project through which
we have been working to come up with a "new vision" for welfare responsibility.
The project represents a very unusual team effort of experts concerned
especially with the moral and religious foundations of a new vision. The team
draws together people from Evangelical, Liberal Protestant, and Roman Catholic
traditions and is forging something quite new across old boundaries within
Christian circles. We are tremendously excited about what is emerging.
You will see in the brochure the names of some of the participants, including,
for example, former mayor of Philadelphia Wilson Goode; Vanderbilt professor
Jean Bethke Elshtain; evangelical leaders Mary Stewart Van Leeuwen and Ron
Sider; Princeton Seminary's new social ethicist (formerly at Andover-Newton)
Max L. Stackhouse; and John Carr, policy specialist at the National Catholic
Conference.
Our team has nearly finished drafting a "vision essay" (about 40 pages) that
will, after further revision, be released to the public at the conference. In
a few days, I. will send yau a copy of the draft so you can evaluate more
closely the four-part argument that will be the focus of debate at the
conference. The published version, to be released on May 19, will itself be
presented as a draft in order to invite critical responses from people across
the country. Later in 1994 or early in 1995 we will then publish a final
version~
We will be more than pleased to arrange the conference schedule so you can join
us at your convenience. The prime times would be late afternoon or evening on
Thusday (May 19) or at breakfast, lunch, or dinner on Friday the 20th.
Thank you for considering this request. We believe that the conference offers
you the best possible opportunity to address a wide. public on the deeper issues
underlying welfare reform. The conference will bring together a high-level
group of ethicists, social scientists, policy analysts and policy makers,
journalists, church leaders, and people who work diligently every day to
ameliorate poverty. We do hope you will be able to join us.
With every best wish as you labor to reform welfare policy--among other things.
yours,
Skillen
Director
JWS/awp
enclosure:
cc.
conference brochure
William Galston, Deputy Assistant the President for Domestic Policy
Wendell Primus, Deputy Assistant Secretary for Human Services Policy
�Commissioned Papers
Team Papers
Charles L. Glenn (Boston University)
"Free Schools and the Revival of Urban Coffimunities"
Bob Goudzwaard (Free University, Amsterdam)
"Who Cares? Poverty and the Dynamics of Responsibility: An Outsider's Contribution to
the American Debate on Poverty and Welfare"
Gina Barclay McLaughlin (University of Michigan)
"Contrasting Perspectives: Reconceptualizing the Poverty Debate"
John Mason (Gordon College)
"Biblical Teaching and the Objectives of Welfare Policy in the U.S."
Lawrence M. Mead (KennedySchool of Government, Harvard University)
"The Poverty Debate and Human Nature"
James W. Skillen (Center for Public Justice)
"The Question of Being Human in Assessing the Requirements of Welfare Policy Reform"
Max L. Stackhouse (Princeton Theological Seminary)
.
"Beneath and Beyond the State: Social, Global, and Religious Changes that Shape Welfare
Reform"
Mary Stewart Van Leeuwen (Center for Christian Women in Leadership, Eastern College)
"Opposite Sexes or Neighboring Sexes? The Importance of Gender in the Welfare
Responsibility Debate"
Other Invited Papers
Clarke Cochrane (Texas Tech University)
"The Christian as Health Care Luddite: Balancing Care and Cure in Health Policy Reform"
Emesto Cortes (Industrial Areas Foundation, Austin, Texas)
"The Iron Rule: Restoring the Status of Citizenship"
Stephanie Baker Collins (Citizens for Public Justice, Toronto)
"Comparative Approaches to Poverty: Problem Identification, Policy Framework, and
Program Response"
Jean Bethke Elshtain (Vanderbilt University)
."Welfare and· Care: Are They in Conflict?"
__
Anne Hallum (Stetson University)
"The Churches versus Poverty in Guatemala: Are lpere Lessons for U.S. Welfare Policy?"
The Ce,nter for Public Justice
•
P.O. Box 48368
•
Washington, D.C. 20002-0368
�.,
···-::-:
. John Hiemstra (The King's College, Ednl.onton)
.
.
"Theory in Service of Policy Making: A Comparative Study of the Social Policy ~eform
' .... ··... ·.' . Work 'Of The Center for Public JustiCe and Citizens for Public"]li'stke-Lanada" . . . . .
.
.
.
.
Palll Marshall (Institute for Christian Studies, Toronto)
"Rights Talk and Welfare Policy"
Stephen Charles Mott (Gordo~-Conwell Theological Seminary)
"Foundations of the Welfare Responsibility of the Government"
Steven.Monsma (Pepperdine University; Calvin Center for Christian Scholarship)
"Poverty, Religion, and Non-Profits"
Cynthia Neal (Wheaton College)
"Breaking the Cycle of Poverty: Accounting for the Pathways of Human Development in
Reforming Welfare"
Marvin Olasky (University of Texas at Austin)
"Towards Welfare Choice"
James M. Shopshire, Sr: (yVesley Theological Seminary)
"Black Churches, Welfare Reform, and the Experiences of African American and Other
People in the Urban Context"
...
Ronald J. Sider (Evangelicals for Social Action)
"Correcting the Welfare Mess: Towards a New Model for Church/State Cooperation"
'
.
-;.
Julia Stronks (J.D.; Ph.D. program in government, Univ. of Maryland)
..
·
"Social Service Agencies and Religious Freedom: State Aid, Regulation, and the First
Amendment" ··
Mary Van Hook (University of Michigan)
"Christian Charity and Social Justice Approaches to Rural Poverty: Contributions and
Limitations"
.... "
.
"
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CENTER FOR PUBLIC JUSTICE
1835 H Forest Drive
Annapolis, MD 21401
-
I
liCJ: carol Rasco
Assistant to the President
for Domestic Policy
The White House
1600 Pennsylvania Ave., N.W.
~lashington, D.C.
20500
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THE:WHI"fE HOUSE
OFFICE OF DOMESTIC POLICY
CAROL H. RASCO
Assistant to the President for Domestic Policy
lfro
Draft response for POTUS
and forward to CHR b y : - - - - - - - - - - - - - - - Draft response for CHR by: - - - - - - - - - - - - - - - Please reply directly to the writer
(copy to CHR) b y : - - - - - - - - - - - - - - - - - Please advise b y : - - - - - - - - - - - - - - - , - - - - - Let's discuss: - - - - - - - - - - - - - - - - - - - - -
·Schedule?:
.f·
�·'
California Chapter, Region E
38414thAve. #125
San Diego, CA 92103
APR
J
4 REC'D
April 4, 1994
Carol A. Rasco
Assistant to the President
for Domestic Policy
The White House
1600 Pennsylvania Avenue
Washington, DC 20500
Dear Ms. Rasco:
I want to thank you for your letter of August 6, 1993.
The Task Form on Reform in Mental Health Care, National Association of Social
Workers, Region E, is aware of your extensive ongoing efforts towards
revamping the Health Care System and appreciate the complexity of the task.
We believe there is a health care crisis.
We have attached a list of statistics we have compiled and an article
demonstrating the
phenomenal
cost
savings
in medical
health
care
expenditures, as well as savings to employers, that occur when mental health
services are utilized. Additionally, we are including documentation of the
vast need and demand for mental health services by the American public.
We believe that psychotherapy effectively helps people quit gangs, curtail
criminal behavior and drug and alcohol abuse, improve school performance and
the quality of family life, assists people in getting off AFDC and obtaining
jobs, training, and education.
In the long run, we believe the benefits to society in terms of social and
economic costs will greatly outweigh the initial expenditures.
Mental health services are important.
Therefore, we ask that you support
legislation that would create parity of mental health benefits with medical
health benefits.
_I'm corning to Washington May 1, and would like to know if I could meet with
you on May 2 or 3. Please contact me at the address below.
Sincerely yours,
TASK FORCE ON REFORM IN MENTAL HEALTH CARE
NATIONAL ASSOCIATION OF SOCIAL WORKERS, REGION E
~ bQ, ~,(UkY\J 1 u..c~
Judith L. Hahn, MSW, LCSW, BCD
7675 Palrnilla Drive #6318
San Diego, CA 92122
(619) 554-0359
JLH:rs
enclosures
Be:tJ
)
�-
-------------------------,
FACT SHEET
THE BENEFITS OF MENTAL HEALTH CARE
MEDICAL CARE SAVINGS
* Panic disorders are associated with the highest rates of utilization of
general medical, emergency, and psychiatric services when compared with
either patients of other psychiatric diagnoses or patients without any
psychiatric diagnoses. 1
* In 1989-92, a health care program for retired military personnel and family
members found after it expanded yearly outpatient psychiatric care-coverage
from $81 million to $103 million, resulted in a net savings of $200 million
because of greatly reduced psychiatric hospitalization. 2
*Analysis of 58 cost offset studies and claims from 6.7 million subscribers
to the Blue Cross Federal Employees Plan demonstrated that medical
utilization decreased 85% after psychotherapy.
The average decrease for
outpatient medical treatment was 22.6%, while all inpatient costs decreased
.
73.4%. 2
*Persons with a history of trauma and physical or-sexual abuse have been
shown to be heavy users of medical and surgical care, and have high rates of
somatic symptoms that require expensive medical evaluations. These symptoms
and costs declined substantially after psychotherapy. 2
* Persons with depression use medical services 3 times as often- as those
without depression. 2
* 6% of those with the most unlimited access use psichotherapy benefits, and
of that group 75% never use more than 12 sessions.
* Persons who receive psychiatric treatment according to their -clinical
·
needs, reduce their medical use rates by 45 to 60%. 2
* Cost-offset research over the past 30 years clearly shows that psychiatric
care can reduce medical care usage and longer health care costs. The classic
impact study by the Kaiser Permanente Plan in California tracked a group of
patients over 5 years (1959-1964). After gaining access to psychiatric care,
they decreased their general medical visits by 62% and their in-hospital days
by 68%. 3
* A company in Utah found that for every dollar spent on psychiatric care,
the company saved $5.78 in medical costs. Employee mental health counseling
helped decreased hospitalization, medical, and surgical costs by 55%. 4
* 50 to 70% of usual visits to primary care physicians are for medical
complaints that stem from psychological factors. Untreated, mental illness
and drug abuse result in massive losses in our national productivity, from
lost work days and lowered efficiency. In 1990, major depression alone cost
an estimated $23 billion in lost work days. 5
* Studies show general inpatient care for physical illness can be cut by as
much as 70% following mental health treatment, and outpatient medical
utilization may be lowered by as much as 20%. 5
over ·. • . .
�'·
•-
..
~'••
SAVINGS IN THE WORK PLACE
* One of the biggest causes of lost days at work is depression, says Mary
Jane England, President of the Washington Business group on Health. Those
days cost employers an estimated $17 billion in 1989. 6
* A study conducted by MIT's Sloan School of Management and the Analysis
Group of Boston estimated that $7.5 billion in lifetime earnings is lost
because of those people who commit suicide because of depression. They also
found that 55% of the total cost of depression, ·or $23.8 billion, are
incurred by employers in the form of worker absenteeism and reduced
productivity. 7
GENERAL MENTAL HEALTH
* According to the Alcohol, Drug Abuse and Mental Health Administration, the
costs of not providing mental health qare are three times higher than the
cost of treatment. 8
* Recent data from the National Institute of Mental Health and the National
Center for Health Statistics, show that 52.4 million adults will suffer from
a mental disorder or substance abuse problem at some time in their lives. 8
* ·The Office of Technology Assessment recently reported that 12 percent of
the Nation's children and adolescents need mental health treatment, but less
than one in five receive appropriate care. 8
* Researchers from the University of Michigan, studied 8,000 people over a
one year period and found that 48 percent suffered at least one (psychiatric)
disorder such as depression. 9
.
* McDonnell Douglas has a mental health benefit with no constraints since
1989.
In the first year, the company saw a 50% decrease in mental health
inpatient admission costs and per capital mental health costs decreased by
34%. 5
* The National Institute of Mental Health estimates that Lithium alone has
saved the United States economy more than $40 billion since 1970 by
stabilizing severely depressed Americans and making it possible for them to
return to work. 6
WHAT THE AMERICAN PUBLIC WANTS
* 98% of the participants in the Parade Magazine survey (published October
31, 1993) say insurance plans should cover medication andjor therapy for the
mentally ill. 10
* 87% think medical plans should provide the same coverage for seeing a
psychiatrist as for other doctors. 10
Compiled by the National Association of Social Workers, Task Force on Mental
Health Care Reform, San Diego Chapter, 3841 4th Avenue #125, San Diego,
California 92103, 619/687-5477, January, 1994.
~
I
'
�REFERENCES
1.
American Journal of Medicine, January 24, 1992, Volume 92.
"Panic Disorder- Relationship to High Medical Utilization",
pp. 1A-10S.
2.
"Psychotherapy is
September, 1993.
3.
The Menninger Letter, January, 1993
4.
The Menninger Letter,
August 1993.
5.
San Diego Union Tribune, December, 1993, p. B7.
6.
"What Price Mental Health?",
7.
Journal of Clinical Psychiatry, November, 1993.
8.
Health Care Security for All: The Single Payer Answer, Summer,
1993, p. 3-12.
9.
ABC News. (Channel 10, San Diego).
10.
Parade: The Sunday Newspaper Magazine, October 31, 1993,
pp. 4-6.
Cost-Effective",
The
Menninger
Letter,
"Hillary Reverses Stance on Parity",
Time Magazine, May 31, 1993.
�Ron Lechnyr, PhD, GSW
THE
CosT
SAVINGS
OF
MENTAL FIEALTII
.SERVICES
W
ways to keep health care costs down, research
showing that mental health services save
dollars goes unnoticed. And while many blame
counseling services for large increases in medical insurance
costs, new, dramatic, and costly medical pr~edures and
. technologies make headlines:
Myths prevail about the ben~fits of psychological counseling services. Statistics are often misrepresented; the data on
mental health costs often confuse or oombine inpatient and outpatient care costs to inflate the true costs. And while mental health
providers come under attack from several fronts, society has perhaps.
never been more aware of the impact of psychological conditions.
This article reviews some of the research related to the cost-savings
of mental health services. The studies serve as proof that mental health
services must be included in any basic health care coverage under current _
health care reform efforts. As for employee assistance program (EAP)
professionals, it is important that they and other health care professionals
share this information with employers, policy makers, insurers, and others to
educate them as to benefits of mental health services.
j
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hile. employers, insurers; and Congress look for
M.-;~:.~ He:cl~ Sen"i.:es Ri:duc~ Medical Overutilizaiio~o
The fact that mental health services reduce medical overu~tion is backed. by over three decades of r~arch.
Studies have shown that mental health care can improve a person's overall health while reducing medical
overutilization by up to 75%. Studies have also shown that th~se who need psychological care yet do not receive it
visit medical doctors twice as often for unnecessary care as those who receive treatment
The National Institute of Mental Health estimateS that 20% of .all adults suffer at least one mental disorder.
However, only 5% ever
a mental health professio~. The rerruiining 95% are seen by family physicians. Yet a
study appearing in a 1989 issue of the Journal of the American Medical Association, (TAMA), found that doctors failed to
recognize or diagnose over half the severe cases of depression. Physicians paid on a fee-for-service basis detected just
54% of depressed patients while pre-paid physicians (those operating in HMO or managed care programs) recog:..
nized only 42% of such people. By comparison, psychologists and psychiatrists correctly diagnosed depression 86%
of the tim~ This is an important finding since depression is a treatable disorder if properly diagnosed and treated
early.
.
·
·
.
·
.
. .. ·
·
American industry would only benefit from assured access to ~~ntal health services for employees: A 1989
Gallup Poll found that stress, anxiety, and depression cost American business billions in lost wages and medical
treatment of related disorders. Approximately 13% of employees experience lower morale, productivity~ loss of
energy, and interest in w?rk. Such employees use more medical_ services and inpatient care, and have higher
see
22 .
· EAP Digest- November/December 1993
�levels of alcohol and drug abuse. Yet
research has shown that employers.
who provide an appropriate level of
mental health coverage have better
employee functioning, fewer costs
related to medical overutilization,
and fewer costs related to expensive
. inpatient psychiatric care-up to
41% fewer costs.
Numerous studies have found
that employees experiencing untreated emotional distress or
depression use both inpatient and
outpatient medical care more than
the average employee. Individuals
with high anxiety have a poorer
prognosis for recovery from coronary care problems. A study ·
appeiuing in a 1989 issue of JAMA
..
..
SafewayStores found
that psychologically
based wellness
. programs redu<:ed
absenteeism and
tardiness by more than
60°/o [and] cut union
grievances by 95o/o.
found that depression resulted in
poorer physical and social functioning, more days in bed, more bodily
pain, and was more disabling than
any other physical disorder except a
current heart condition. Furthermere, d~pr""ision complicates other
physical disorders "producing.
roughly twice the reduction in social
.functioning produced by either
condition.alone," researchers found.
At least one study showed that
·
depressed patients treated by
general physicians have poorer
physical functioning and experience
more pain and more days in bed
than patients treated by a merital
health professional.
This same study is significant in
view of a 1980 study appearing 4t
the American Journal of Psychiatry,
which showed that 7.3% of insured
patients sought services for psychological conditions-yet over half the
claims for such services were
submitted by general physicians,
not mental health professionals.
~-
Mental Health Services Reduce
Insurer Costs
Research supports. the fact that
everyone benefits from mental
health services-patients, employers, even insurers. A study of Kaiser
Permanente patients who received
psychotherapy showed a 77.9% .
decrease in the average length of
stay in the hospital, a 66.7% decrease in frequency of hospitalizations, a 48.6% decrease in the numher of prescriptions written, a 48.6%
decrease in the number of physiclans seen for office visits, a 47.1%
decrease in physician office visits, a
45.3% decrease in emergency room
visits, and a 31.2% decrease in telephone contacts. The study was
conducted by the Portland State
University School of Social Work. It
concluded that psychotherpay
resulted in and overall cost savings
·of 53%. Other studies, including
several by Blue Cross and Blue
Shield, show similar results. A 1978
Blue Cross study showed that
medical costs dropped by $9.43 per
patient per month, from $16.47
before psychotherapy to $7.04 after.
Studies of early psychological
interventions for employees of
Utah's Kennecott Copper Company
found that, one yec.r after therapy,
absenteeism was reduced by 49.5%
(from 5.8 to 2.93 days per month);
weekly indemnity costs dropped by
64.2% (from $70.67 to $25.33 per
person per month); and, hospital/
medical/ surgical costs fell by 48.9%
(from $109.04 to$56.91 per person
per month). Employees not involved .
in therapy tended t0 get worse,
showing increases of 2.9% in absenteeism, 28.5% in weekly indemnity
costs, and 7.7% in hospital/ medical/
surgical costs.
·
Safeway Stores found that psychologically based wellness programs
reduced absenteeism and tardiness
by more than 60%, cut union grievances by 95%, and virtually elirni- .
nated lost work days from accidents.
As billions of dollars are lost each
year because of the effects of emotiona! problems on employee
productivity, these findings are
significant.
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EAP Digest -November/December 1993
23
�-------
~----
~-
---~-~--
•
•
Examination _Date:
Cut-off Date:
Examination Date:
Cut-off Date:
;
May 14,1994
March 18; 1994
December 3, 1994
October 7; 1994
for information.·
write the EAP Association, Attn: EACC
4601 North Fairfax Drive, Suite 1001
Arlington, VA 22203
.
•
or call:(703) 522-:6272
Circle It 14 on Reader Service Card
sponding
I
i
nineties.
I
i
I
i
*
Circle 15 on Reader Service Card
24
Mental Health Services are
Short-Teim
myth that psychotherapy is a
long-term commitment just isn't the
case for a majority of patients. In
studying 31 PhD andMSW mental
health providers, the Eugene, Ore.,
HMO/managed care program,
SelectCare, found that the average
number of therapy sessions over a
three-year period was only 5.4 yisits
for all providers. A year later, it was
4.3 visits. (Analysis also showed that
mental health benefits constituted
only 7 /lOths of 1% of SelectCare'.s
entire budget) Similarly, Capital
Health Care, an HMO based out of
Salem, Ore., found that subscribers
seeking psychotherapy in 1990 aver- ·
aged five psychotherapy sessions.
Other studies reached the samP.
results. Though some patients require
long-term care, most require only a ·
few, brief sessions.
The
•
Though some
patients require
long-term care, most
require only a few,
brief sessions.
-
Mental Health Services Can Rectuce
Workers' Compensation Costs
For too long now, employers have
looked at disability and workers' compensation issues only in the context
oi physical injury. Yet astudy appearing in the Journal of Pain found that
several psychosocial variables-not
physical or medical issues-were ·
associated with an employee's returnto-work at six months. Relying on
physical factors misses the mark.
Employers must also consider an
employee's psychosocial condition.
Unfortunately, psychos¢a!
factors are seen by insurers, employers, and others as a sign of weakness
rather than a "real and natural part"
of an injury or disability. Fearing
that such factors mean a case has
gotten out of ctmtrol, efforts shift
to an adversarial, legal realm that
EAP Digest- NovemberiDccembcr 1993
�can result in "blaming the victim" so
the caSf:! can be closed. Yet that only
leads to more problems while
ignoring the potential for a taskcentered, short-term, psychological
solution. Psychological intervention
should be seen as a necessary and
natural part of any health care
intervention.
Psychological care should not be
offered as separate from the health
care system, but as a part of it.
Psychological issues are a natural
part of any health care problem. The
way to help people rapidly improve
is to provide psychological care in
conjunction with medical care
without then~ to be "mentally ill"
or having "psychological problems"
as a justification.
.
Mental Health Services Redlice Costs
Associated with Chronic lllness
Appearing before the U.S. Congress
in 1990, Senator Daniel Inouye (DHawaii) andNicholas Cummings,
PhD, psychologist and former president of the American Psychological
Association, reported the results of a
four-year study involving Medicaid
recipients and Federal employees
who received brief, focused mental
health services. The results showed
that patients who received "targeted,
focused, and brief" psychological
services experienced a 35% to 38%
drop in subsequent medical costs.
This held true for both groups, e~en ,
though the Medicaid group had
consistently required more medical
care than the Federal employee
group. Treatment was brief and averaged 6 to 8 sessions provided by
psychologists and psychiatrists.
Those who received no psychological services, or traditional therapy
addressing the patient's total psycho=logical condition (non-targeted problems), experienced either no change or
increased their medical costs by 25%.
The study also found that patients
with long-term, chronic illnesses (i.e.,
diabetes, airway-respiratory disease,
ischemic heart disease, or hypertension, etc.) who received targeted
psychological services saw their
medical costs decline by 18% for the
Medicaid group and 31% for the
Federal employee group. Traditionally, these patients have been
regarded as hard to impact or change.
Medicaid patients with alcohol or
.. services generate panic among
other drug problems who received
employers and. legislators. Yet a .
targeted psychological services ·.. .
1992 Physician's Financial News
reduced their subsequent medical
article concluded that, while
costs by 15%, while generalized
utilization of mental health
psychological therapy led to a 2%
services has increased in recent
reduction. Even more revealingyears, overall mental health costs
medical costs increased 90% over the
have stayed at a manageable 6% to
next 12 months for those not receiv7% of the total health insurance '
ing psychological assistance.
costs. Claims of skyrock£ting costs
use atypical cases or misleading
The Cost of Mental Health Services
statistics, and such claims may use
are Not Out of Line
only one case example to make the
Studies suggesting increases of 24%
point. This is poor research, but it's
to 33% in utilization of psychological
"Coming home from work
to the kids is stressjiiJ. ..
these strategies work!"
; ... '
(j
u
• "Employees understanding of anger
•
•
management skills also worked
: to better their understanding of
····~·················
"We suppor•t Prr~paring ror the : pr:1ssure! t'~ t!!e job···"·
Drug Free Years because it Is
• • • • • • • • • • 'We want to reach
pro-active, not reactive ••. "
•
.
all our employees."
..
Preparing for the Drug Free Years. ·
is a 10 hour training program using a
,variety of audio/visual materials that
will give your employees the skills
they need to reduce the risk of drug
and alcohol problems in their families.
ReSearch-based, tested and
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Circle It 16 on Reader Service Card
EAP Digest- November/December-1993
25
�II
·'
· what happens in the politics of..
Mental health services are not being
health care. .
overutilized. Instead, society is more
· Utiliiation has increased largely aware of how to achieve a better, ·
because mental health services
healthier life. Blocking access to mental
weren't available at present levels 10 health care through "closed panels" of
years ago. Furthermore, only in the
last 15 to 20 years has mental health
care been mandated in health
insurance coverage. Medicare only
Society
better
started to include psychologist and
clinical social work providers a
it
a
to blame,
little over two years ago. Before
and mental health·
that, people did not seek help until
the problem was too difficult or
semces are ~easy
until it was too late.
target-.its
are
Increased utilization. rates also
ignore the fact that society is more
.not vocal, ~rgariized,
aware of alcohol and other drug
or strong enough
addictions than it was 10 years ago,
and that society is also more conto
cerned about such issues as child
~1a!Jn.
abuse, incest, sexual abuse~ the ·
impact of traumatic events, divorce,
dysfunctional families, single .
parenting, step /blended families,
.
and behavioral problems. Reports of provide~, or denying, rationing, or
employee costs averaging $200 a
limiting care saves money in the shortyear for mental health care ignore
. run, yet as already mentioned increases
the fact that such cov~rage also
costs in the long-run.
,
includes the employee's family.
Finally, consider what happened
~hen
feels
has victim
.
'victirris'
politically
. any
.Q
cause
IJA!!it~AKS
Short Term Rapid Inpatient Stabilization with Step Down Partial
Hospitalization Programs followed by community based
referrals for outpatient care
To make a. referral, call our professionally staffed
.Crisis Assessment Center, 24 hours a day, everyday.
Calll-800-537-7924
• JCAHO Accredited • CSAS Ucensed • State Ucensed
• Moat Insurance Plans Accepted .
· when the State of Oregon mandated
that Blue Cross of Oregon cover
mental health services at the same
level as physical disorders. According to the state's Health Planning
Office, it actually became less costly
to provide these services because
patients were seen earlier for· ·
shorter duration ofservices and did
·not require more expensive inpa- ·
. tient psychiatric hospitalization. ·
This provides important support
for making outpatient mental
. health services more readily available to patienls--'-it holds down the
overall health care dollars.
Why. Is the Research Being
Ignored?
·
Unfortunately; the research on the
benefits of mental health services
g()E!S largely ignored for a number
of reasons. Most people do not
know that depression is a disease
. that is successfully treated in 80%
of the cases. A 1991 study by the
National Mental Health Association
found that although half the population admits that they or a family
member have suffered from
depression, 43% believe depression
is .a personal weakness. Alcoholism
was viewed as a personal weakness
by 58% of those surveyed. Also,
.
30% of those depressed or ~th a depressed family member would not
want friends to know about the problem, proving that there is a stigma still
attached to psychological problems.
Another reason the research is
being ignored: The current economic climate and rising health care
costs have led to pressures to find
solutions. Society feels better when
it has a victim to blame, and mental
health services are an easy target·its 'vict:itri.s' are not v<X:a~, organized, or strong enough politically
to cause any harm.
Further aggravating the issue is
the fact that mental health professionals-psychiatrists, psychologists,
and social workerS, for instanceare not politically organized into .
one group. This makes it easy for ·
others to 'divide and conquer' and
encourage rivalry and conflict. As .
such, individuals are easily caught .
up in the wrong issues, leaving little
energy for the importance of mental
~th coverage in health care.
. continued on page 43
'· Circle # 17 on Reader Service Card ·
26
EAP Digest- November/December 1993
�i
'
i
continued frrmr page 26
Among the real reasons behind
rising health care costs ~ the uninsured patients who are unable to pay
their bills, which forces providers to
"pass along" these costs to patients
with insurance co.verage. To cover
these costs, efforts are directed at
restricting insurance coverage,
rationing care, dez:lying access,
adding more evaluation costs, and
terminating coverage, While this is
happening, government is. cutting
back on funds for mental health
services because of its economic
reality-which only forces patiei;lts
to rely on the private sector. In the
meantime, finding solutions to the
problem of insurance coverage takes
a baclGeat to cost-shifting, a!lc!
everyone loses.
Another reason: In a February 20,
1992 article in The Oregonian, psychiatrist Dayid Kirkpatrick, MD,
compared the health care delivery
systems of the United States and
Canada. Having worked under both
systems, Kirkpatrick noted that
Americans are fond of their health
care technology, which leads hospitals to buy the latest, most advanced
diagnostic equipment Americans
also expect their providers to be
perfect and insist upon expensive
efforts to prolong life. Hproviders
do not over-extend their efforts at
the end of life, malpractice suits and
settlements would inflate their costs
to a level equal to the cost of the
new technologies.
·
[R]esmcting
psychological
services and access
to such care only
increases costs and
the inappropriate
use of medical
.
semces.
Canada, in part because the U.S. has
twice as many people working in ·the
administration of health care than in
Canada. U.S. insurance companies
spend more money on pre-certifications, second optnions (which,
research shows, have no impact on
the original decision), utilization
reviews, and challenges to provider
decisions, among other activities.
Add to this the consultants, insurance specialists, administrators,
reviewers, and marketing personnel,
and the costs climb even higher.
As the research shows, restricting
psychological services and access to
such care only increases costs and
the use of medical services in inappropriate ways. Such services can
and should J:>e provided for in a
coordinated and focused manner. •
See page 46 for a list of recommended
readings.
Ron Lechnyr, PhD, DSW, is president,
clinical medical psychologist, and clinical
director of Oregon Health & Rehabilitation
located in Springfield, Ore. He also has a
- - - - - - - - - - - - · . private practice in Eugene. For his work in
promoting awareness of the cost-effectiveness of mental health services, Dr. Lechnyr
As for overhead, administrative
received the Oregon Psychological
costs in the U.S. are twice that of
Association's Labby Award in 1990.
If the patient is covered by insurance, their EAP/Managed Care
is controlling where they will b~ treated.
So, how do you let the decision makers know you're out there?
..
EAP Digest
.
TREATMENT DIRECTORY.
.........______
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~=·,!~.a:;:u:!,~~~':':~
EAP DIGEST Treatment Directory.
For just $90 per issue your facility will be right at
our readers' fingertips 6 times a year when they
~=~~~a:;:o=:~ ~~c:0::~tm;'.J,~~ectocy
enough space for your prograril"s name, address,
phone number, and a 50-60 word description
of your services ..
~~ fi~ =-;_:;
=--~-::?7':=::-~f" :::..: -=
:::.-::===.;;;···--- -:-:.-==--::;..~-::.·=:.:.::
:::-:::;:=
_.::-_
~==---..::..-=--=:. . = --
.~ }i; ~
caJ lhe advel1ising department today at
1-800-453-7733
IUid wa11i1 you il on d the clalaia.
Cirele #32 on Reader Service Card
EAP Digest- November/December 1993
'
.·:
·.
�":·
· -REFERENc;ES "- ··
»Writing as a Tool for Treating
Trauma," pages 19, 42
. .·
The "offset effect" of mental health treatment on
ambulatory mediciU care utilization and charges:
Month-by-month and grOUped month analyses
1. E.K. Baker: Use of journal writing for
of a five-year study. Archives of General
psychologists. In P.A. Koeller and S.R. Heyman
Psychiatry 42:S73-S80, 198S.
(eds.),Innovalions in Clinical Practice: A
Bowling, C., Mackabee, A., and A. Gannon:
Source Book. VoL 7. Sarasota, FL.: Professional·
Capitol health care: Managed mental health care
Resource Exchange, Inc., 1988, pp. 269-282.
initiatives, 1986, 1987, 1988, and 1989, SaJem,
2. J. Barron: Poetry and therapeutic
Oreg., May 9, 1990.
communication: Nature and meaning of poetry~
·.Brasch, P.: A helping hand from the boss.
Psychotherapy: Theory, Research and Practice
Parade Magazine, June 8, 1980, 14-17.
11, p. 1, 1974.
·Cross, D.• Sheehan. P., and Khan, J.: Short3. K. Edgar: A case of poetry therapy.
and long~t~rm follow-up of clients receiving
· Psychotherapy: Theory, Research and Practice
insight-oriented therapy and behavior therapy.
16. p. 1, 1979.
Journal of Consulting and Clinical Psychology
4. S. Farmer: Adult Children of Abusive ,
S0(1):103~112, 1982.
Parents. Los Angeles: Lowell House, 1989.
· Cummings, N.: Brief psychotherapy shown
S. MJ. Mahoney: Some applied issues in
to reduce utilization of medical resources;
self-monitoring. In J.D. Cone and R.P. Hawkins
Evidence still ignored. Psychiatric News, Oct.
(eds.), Beh!!vioral M!~S!Men!: New Directions
IS, 1~82.
. , . ·"
_: .
in CliniCal Psychology. New York: Bniner/
Cummings, N.: ·•saving Health Care Dollars
Maze!, 1977.
'Through Psychological Service." Paper
6. F.M. Ochberg: Post-traumatic therapy.
presented at a meeting cosponsored by Hon.
Psychotherapy 28, pp. S-IS, 1991.
O.K. Inouye, Hon. M. Baucas, and the
7. D.R. Suffridge: Survivors of child
American Psychological Association,
maltreatment: Diagnostic formulation and
Washington, D.C., May, 198S.
therapeutic process. Psychotherapy 28, pp. 67- ·
Cummings, N.: Psychologists: An essential
1S, 1991.
component to cost-effective, innovative care.
8. M.R. Trimble: Post-traumatic stress
Psychotherapy in Private Practice: The Journal
disorder: History of a concept. ID C.R. Figley
for the Independent Practitioner 10(12):137(ed.), Trauma and Its Wake: The Study and
143, 1992.
.
Treatment of Post-traumatic Stress Disorder.
·Epstein, N., and Volk, L: Research on the
New York: Bruner/Maze!, 198S.
. results of psychotherapy: A summary of
9. B. van der Kolk: The psychological
evidence. American Journal of Psychiatry
. consequences of overwhelming life experiences. "138(8):1027-103S, 1981.
.
In B. van der Kolk (ed.), Psychological Trauma.
Flor, H.,' Haag, G., Tuit. D., and Koehler,
Washington, D.C.: American Psychiatric Press,
H.: Efficacy ofEMG biofeedback.
Inc. 1987.
.
.
pseudotherapy, and conventional medical
10. B.G. Braum: The·BASK model of
treatment for chronic rheumatic back pain. Pain:
dissociation. Dissociation 1, pp. 4-lS, 1988.
The Journal of the InternatiOnal Association for
11. C.A. Courtois: Healing the Incest
the Study of Pain 17(1):21-31, 1983.
Wound: Adult SUrvivors in Therapy. New York:
Follett, W., Cummings, N.: Psychiatric
w.w. Norton &.Co., 1988.
services and medical utilization in a prepaid
health plan setting. Medical Care 5:2S-3S, 1967.
'Gallagher, R.. Raub. V., Haugh, L.,
FOR
READING. Milhous, R., Callas, P., Langelier, R.,
McClallen,J., and Frymoyer,J.: Determinants
of return~to-work among low back pain patients.
"'The Cost Savings of Mental
. Pain: The Journal of the Intemntional
Association for the Study of Pain 39:SS-61,
Health Service.;," page 22-26, 43.
1989.
American Psychological Association: Grant, R.:'"SCcond Report on Oregon's
"Medical Cost Offset: The APA Practice
Experience With Remodeling Insurance
Directorate." Washington, D.C., January 10, .
Benefits for Mental Health and Chemical
1991.
Dependency." Report to the 64th Oregon
"Are Mental Healthcare Costs Out of line'?"
Legislative Assembly on Implementation of
Physicians Financial News, January IS, 1992.
'ChaptC!' 601, Oregon l.:.aws 1983. Oregon State
Barsky, A.. Wyshak. G., and Klerman G.:.
· Health Planning and Development Agency, .
Medical and psychiatric determinants of
Salem, Ore., Dec. IS, 1986.
outpatient medical utilization. Medical Care
Hayashida, M.• Alterman, A.. and McLellan.
24(6):S46-S60, 1986.
·· A.: Comparative effectiveness and costs of
Beckman. E.: The comparative efficacy of
impatient and outpatient detoxificatio~ of
psychotherapy and pharmacotherapy in
patients with mild-to-moderate alcohol
depression: Implications for clinical practice.
withdrawal syndrome. New Etigland Journal of.
Psychotherapy In Private Practice 2:31-34,
Medicine 3S8-36S, 1989.
1984.
Herrington, B.S.: Mental health coverage
Blomquist, D., Gray, D.. and Smith, L.:
Said controllable. Psychiatric News Sept., 21,
Social work in business and industry. Social
1979.
.
Casework 60(8):4S7-462, 1979.
·
Hiratsuka, J.: Brief mental health care can
Borus, J., Olendzki, M., Kessler, L, et al:
FURTHER
. 46
reduce medica! costs and over-utilization: A
report to congress. NASW News June 19, 1990.
Holden. C.: Alcohol treatment and the
medical care cost crunch. Science 23S: 11321133, March 6, 1987. ·
Holder, H.• and Hallan, J.: Alcoholism
insurance benefits may reduce health care use.
Psychiatric News Nov. S, 1982.
Holder, H.: Alcoholism treatment and
potential health care cost savings. Medical Care
2S(l)S3-71, 1987.
Howard, K., Davidson, C., O'Mahoney, M.,
Orlinsky, D., and Brown, K.: Patterns of
psychotherapy utilization. American Journal of
'Psychiatry 146(6):77S-778,June, 1989.
Jansen, K.: Emotional disorders and the
labour force: Prevalence, costs, prevention and
rehabilitation. International lAbour Review
12S(5):60S-61S, 1986.
Kernberg, 0.: Borderlines require honesty for
successful treatment..Psychiatric News Nov. 19,
1982.
Kirkpatrick, D.: Even doctors like Canadian
health care. The Oregonian Newspaper Portland,
Ore., Feb. 20, 1992, B-1.
Krizay,J.: Federal employees' use of services
stable. Psychiatric News 16(18):1, Sept. 18.
1981.
Krizay,J.: Federal employees' experienc~ as
a guide to the cost of insuring psychiatric
services in the various states. American Journal
of Psychiatry 139(7):866-871, July, 1982.
Lechnyr, R.: Evaluations of chronic pain
patients. Oregon Psychology: The Journal of the
Oregon Psychological Association 36(2): 12-lS,
Summer, 1990.
Lechnyr, R.: Special edition: Important
information on health care cost savings. The
Oregon Pain Center News Springfield, Ore.
Winter, 1990.
Lechnyr, R.: Cost savings and effectiveness
of mental health services: Oregon Psychology:
The Journal of the Oregon Psychological
Association 38(2):8-12, Summer, 1992.
Lipowski, Z.: Linking mental and medical
health care: An unfinished task. Psychosomatics
29(3):249-253, 1988,
Liptzin. B.• Regier. D., and Goldberg, 1.: .
Uthizatior. of !-.ealth and mentcl heelth services
in a large insured population. American Jou1711ll
ofPsychiatry131(S):SS3-SS8, May, 1980. .
. Massad, P., Wl".st, A., and Friedman. M.:
. Relationship between utilization of mental health
and medical services in a VA hospital. American
Journal of Psychiatry 147:4, April, 1990.
· Meltzriff,J., and Kornreich, M.: Therapy: It
works. Psychology Today 1S:S7-6l,July, 1971..
- Miller, L, Norman, W.. and Keitner, G.:
Cognitive-behavioral treatment of depressed .
inpatients: Six- and twelve-month follow-up.
American Journal of Psychiatry-146(10): 12741279, October, 1989.
Miller, W.. and Hester, R.: Inpatient
alcoholism treatment: Who benefits? American:
Psychologist 41 (7):794-805, 1986.
Mumford, E.• Schlesinger, H., Glass, G.. and
. Patrick, C.: The effects of psychological
intervention on recovery from surgery and heart
attacks: An analysis of the literature. American
~Digest-
November/December 1993
�••
........
. .•
Joumal of Public Health 72:141-151, 1982.
Mumford, E.. Schlesinger, H.• Glass. G.•
Patrick. C.• and Cucrdon. T.: Psychotherapy
reduces costs of other care. American Journal of
Psychiatry OcL. 1984.
"New Research on Therapy Vs. Medical
Costs." Psychotherapy Finances 10(4):8, May
16. 1983.
Nonon. W.: Medical ethics and quality of
care under workers' compensation. Wayne
Nonon. MD. Medical Administrator. State
Accident Insurance Fund, March 25. 1987.
"Of Mental Health Services: Small Cost
Increases Seen for Expanded Coverage,"
American Medical Nms 16, June 3, 1983.
"Psychological Health Benefits Cancer
Patients: In Study, Suppon Aided Mood.
Reduced Recurrence," American Medical Nmi.
April 20. 1992.
Pursar, A.: Psychotherapy found to reduce
hospital bills. Psychotherapy in Private Practice
92-93, Winter, 1983.
Ramanathan. C.S.: EAPs response to
personal stress and productivity: Implications for
occupational social work. Social Work
37(3):234-239, May, 1992.
Rice. B.: Can companies kill? Psychology
Today 78-85. June, 1981.
Rukeyscr. E. and Han. P.: Many think
depression is weakness. The Register-Guard
Nmspaper, Eugene. Ore.• Dec. 11, 1991. 7-A.
Sabashin, M.: APA repon: Oaims of big
jumps in services inflated by substance abuse,
child care. Psychiatric Nms 22, Jan. 18. 1991.
"Savings of SS for Every $1 Spent on Mental
Health." Psychotherapy Finances 8(9):8. Dec.•
1981.
Schneider. C.: Cost effectiveness of
biofeedback and behavioral medicine treatments: A review of the litcramre. Biofeedback
and Self-Regulation 12(2)71-92. 1987.
Somerville, J.: Gallup fmds pervasive ·
absenteeism: Stress costing billions. American
Medical Nms 10, Nov. 10. 1989.
Smith. D.. and Mahoney, J.: McDonnel
Douglas corporation: Employee assistance
prngram fll1l!!lc'.ai offset study 1985-1988.
Sten. P.. and Young, L.: "Social work
intervention and patients • utilization of the
Kaiser Health Care System." Thesis submitted in
partial fulfdlment of the requirements for the
degree of Master of Social Work. Ponland State
University, 1977.
"The Cost Savings of Mandated Alcohol and
Drug Treatment: A Study of the Addictions
Trcaunent Association." Addictions Treannent
Association. Ponland. Ore.• April. 1989.
TurkingtOn. C.: Help for the worried well:
Psychological intervention cuts medical and
hospital costs and helps people feel better..
Psychology Today44-48. August. 1987.
Wells. K.. et al: Depression as disabling as
physical illness. Journal of the American
Medical Association August 18. 1989.
Winslow. R.: Spending to cut mental-health
costs: Employer fmds quality care the best buy.
The Wall Street Joumal Dec.• 1989.
When your employee comes ~.~...~. .
11.
he won't come back alone.
That's because at St\1}'\·esant Square, our individ•Jalized inpatient and outpati'!nt treatment programs are designed to help
recovering employees with the chlillenging transition to a' productive,
chemical-free fife. Our intensive inpatient treatment includes two full
years of Mtercare, and our outpatient program lets your employees
stay on the job while getting treatment during convenient everung
hours. The Mtercare and outpatient programs are just two facets of
~ur comprehensive, hospital-b3sed treatment ~proach which provides
our patients~your employees-with the knoWl~. skills and support
they need to understand and overcome chemiCal' dependence.
To find out how we can help your chemically dependent
employees become productive again, please call us o~ .write for our
brochure.
.. Stuyvesant·Square .
·
•
The Chemical Dependency Treatment Program
. of Beth Israel Medical Genter
·
170 East End Ave. at 87th SL, New York, NY 10128
870-9777
EAP Digest- November/December 1993
�~~·~
·.,· ..
• ., -
NASW
'•
~·
···,:
I
I
____;;:;:._; --
.
f;"-*"-';.i'"-':I'~';<'~;2Zf:'r:ifa~"'!.f' ,..- -~~lfiJfOM
California Chapter, Region E
38414thAve. #125
San Diego, CA 92103
~'>
i
i
I
"-'-:t'""''"-----'
I
:','·
Carol H. Rasco
Assistant to the President for Domestic
Po
The White House
1600 Pennsylvania Avenue
Washington, DC 20500
-:o,_
~
~--------------
;
.:.... :. ~
'
'' - . .
-·-
·•·.'
·.· ...
~
...
·
lie~
�.. _------- --.2'1
THE WHITE HOUSE
APR I 5
R~n
OFFICE OF DOMESTIC POLICY
CAROL H. RASCO
Assistant to the President for Domestic Policy
To:
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Draft response for POTUS
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Schedule of Events
First and Second Rounds of Competitioil
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1600 Pennsylvania Avenue; N..-w.
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THE WHITE HOUSE
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OFFICE OF DOMESTIC POLICY
CAROL H. RASCO
Assistant to the President for Domestic Policy
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�Princeton University
Woodrow Wilson School
of Public and International Affairs
Robertson. Hall
Princeton, New Jersey 08544-1013
FAX (609) 258-2809
APR
7 REC71 .
April 4, 1994
Ms. Carol Rasco
Assistant to the President
for Domestic Policy
The White House
1600 Pennsylvania Avenue
Washington, DC 20500
Dear Ms. Rasco:
On -behalf of the. Woodrow Wilson -:school- or Public and International· Affairs, Princeton
..University, we would like to invite you, to ·:attend -a conference on "Sociar PoliCies- for Children~"
beginning on Wednesday evening,.May 25-with adinherat the Nassau lrirf'and coridudingmid-afternQon
on·Friday, May 27, 19914-.
The conference will feature seven specific proposals for improving children's lives in the areas of
education, health, economic security, physical security, labor force attachment, child abuse, and child
care. We have invited leading experts in each of these fields to write papers spelling out their "ideal"
program or agenda. The papers will be circulated prior to the beginning of the conference and will serve
as a basis for the discussion. During the conference, each proposal will be evaluated by three types of
respondents: 1) an academic expert on the substance of the policy issue at hand, 2) a political actor or
analyst who will address the likely trajectory of such a proposal during the process of enactment, and 3)
an implementor who will talk about the potential consequences of the proposal at the community level.
By starting with a concrete proposal, and by choosing commentators from a variety of perspectives, we
hope to stimulate a lively discussion that will be useful to policy~makers and implementors as well as to
academics.
The two and one-half day conference will begin on Wednesday evening with dinner at the Nassau
Inn followed by a debate on the respective roles of government versus families in protecting children and
promoting their well-being. we· have reserved a block of rooms at the Nassau Inn in Princeton which
is located directly across from the University campus. The hotel will hold these reservations only until
April 25. Make your hotel reservation directly with the Nassau Inn and identify yourself as an attendee
of the "Childrei1's Conference" to receive the University rate of $95 per night.
Information about the logistics of the conference including transportation to and from Princeton
as well as details about lodging, meals, etc. is enclosed. You will also find an agenda of the conference,
map of the campus, and a self-addressed postcard to be returned to us confirming your attendance.
�Ms. Carol Rasco ·
April 4, 1994
Page 2
Please do not hesitate to be in touch with the conference organizers if you have any additional
questions.· We look forward to welcoming you to the School for what promises to be an interesting and
most worthwhile conference.
Sincerely,
~,B~J
Irwin Garfinkel
Jennifer L. Hochschild
Sara S. McLanahan
Mitchell/. Ginsberg
Professor of Contemporary
Urban Problems
Professor of Politics and
Public Affairs
Professor of Sociology
and Public Affairs
212/854-8489
609/258-5634
609/258-4875
pt
Enclosures
�"SOCIAL POLICIES FOR CHILDREN"
Princeton University
Woodrow Wilson School of PUblic and International Affairs
Robertson Hall--bodds Auditorium
May 25 - 27, 1994
May 25
6:30p.m.
Dinner, Welcome and Panel'
The Contested Legitimacy of
Social Policies for Children
Nassau Inn, Senior Room
William Galston, White House Domestic Policy Staff
Glenn Loury, Boston University
Robert Rector, The Heritage Foundation
Theda Skocpal, Harvard University
·May 26
8:30a.m.
Buffet breakfast
WWS, Shultz Dining Room
9:00a.m.
Schooling
Dime Ravitch, Brookings Institution
Ramon C. Cortines, New York City Public Schools
Amy Gutmann, Princeton University
Nomi Maya Stolzenberg, University of Southern California
John F: Witte, University of Wisconsin
11:00 a.m.
Income Security for Children
Irwin Garfinkel, Colwimia University
Timothy J. Besley, Princeton University
Ronald Haskins, Coinmittee on Ways and Means
Hugh Heclo, George Mason University
12:45 p.m.
Lunch
WWS, Shultz Dining Room
1:45 p.m.
Physical Security for Children
John J. Dilulio, k, Princeton University
Jameson W. Doig, Princeton University
Kathleen Kennedy Townsend, Bureau of Justice Statistics
Peter Reuter, University of Maryland
Elsie L. Scott, New York City Police Academy
4:00p.m.
Child Care
Barbara Bergmann, American UniversitY
Andrew Cherlin, .Johns Hopkins UniverSity
Maria J. Hanratty, Princeton University
Lawrence Mead, Visiting Professor, JFK School of Government
Deborah Phillips, National ReSearch Council
7:00p.m.
8:30p.m.
Dinner
Keynote address
Prospect Faculty Club, Garden Room
8:00a.m.
Buffet breakfast
WWS, Shultz Dining Room
8:30a.m.
Health Care for Children
Julia Lear, Making the Grade
Robert Johnson, New Jersey Medical School
Kristin C. Luker, Princeton University
Lorraine V. Klerman, Univ~rsity of Alabama at Birmingham
Paul E. Starr, Princeton University
10:30 p.m.
Transition to Work
Robert Lerman, American University
Stephen F. Hamilton, Cornell University
Alan B. Krueger, Princeton University
Ronald B. Mincy, The Ford Foundation
Cecilia E. Rouse, Princeton University
12:15 p.m.
Lunch
WWS, Shultz Dining Room
Child Abuse
DoUglas Besbarov, American Enterprise Institute
May 27
1:15p.m.
Marva Hammon, NYC Human Resources Administration
Sheila B. Kamerman, Columbia University ·
Deanna L. Pagnini; Princeton University
Michael Wald, Department of Health & Human Services
3:00p.m.
Concluding Comments
Jennifer L. Hochschild, Princeton University
Sara S. McLanahan, Princeton University
March 31, 1994
�"SOCIAL POLICIES FOR CHILDREN"
Princeton University
Woodrow Wilson School of Public and International Affairs
Robertson Hall
Dodds Auditorium
May 25 - 27, 1994
LOGISTICS
LOCATION
The conference is held on the beautiful campus of one of America's oldest universities,
Princeton University, in the small town of Princeton, New Jersey, 50 miles from New
York City and 50 miles from Philadelphia.
The University was chartered in 1746, forty-three years before the American Revolution,
and oyer the years has taken its place among the finest universities in the world. Na8sau
Hall, Princeton's oldest. building, was the home ·of the Continental Congress, the
governing body of the American Revolution, and was at a later time the seat of the capital
of the new nation. Nassau Hall survived a bombardment during the Battle of Princeton
·
in 1777 between American and British forces.
Sessions are held in Dodds Auditorium, Robertson Hall at the Woodrow Wilson School
of Public and International Affairs. The School is located at the comer of Washington
Road and Prospect Avenue.
CONTACT PERSON
Ms. Patricia Trinity, your contact person, is located in Robertson Hall, Woodrow Wilson
School, Room 432 (609/258-2925):
Concerns or special · requests regarding ·
accommodations, meals or travel should be addressed to her.
LODGING
We suggest because of its locale that conference participants reside at the Nassau Inn
which is located direetly in front of the University campus on Palmer Square.
A block of rooms at the Nassau Inn have been reserved. You must make your reservation
directly with the Inn and identify yourself as an attendee of the "Children's Conference"
to receive the University rate of $95 per night. The policy for cancellation at no charge
is up to 4:00p.m. on date of arrival. The telephone number of the Inn is 609/921-7500;
Fax: 609/921-9385. Parking facilities are available to hotel guests.
MEALS
Welcoming dinner on Wednesday, May 25 will be held in the Senior Room of Nassau Inn.
All meals during the conference will be served in the George P. Shultz Dining Room,
Woodrow Wilson School of Public and International Affairs with exception of the dinner
on Thursday, May 26 which will be held in the Garden Room of the Prospeet Faculty
Club located on campus.
PARKING
There is limited metered on-street parking on campus. Lot 21 (highlighted on the enclosed
campus map) is available for guest parking. On May 26, shuttle service will be provided
from Lot #21 to and from the School between 8 a.m. and 9:15 a.m., and foilowing
dinner ..On May 27, shuttle service will be available from Lot #21 to and from the School
between 7:30a.m. and 8:45a.m., and 3:30p.m. and 5 p.m. Vans will leave the parking
lot and the School approximately every ten minutes.
March 10, 1994
�"SOCIAL POLICIES FOR CHILDREN"
Princeton Uruversity
Woodrow Wilson School of Public and International Affairs
Robertson .Hall
Dodds Auditorium
May 25 - 27, 1994
TRANSPORTATION INFORMATION
BY TRAIN
From Washington: the Amtrak train takes 2 l/2 to 3 hours to Trenton. Mqst trains stop in Trenton, and a few stop
in Princeton Junction. Taxis are available at the Trenton station and may be at Princeton Junction. During the day,
taxis cost about $20 per person from Trenton; $2 for each additional person. From Princeton Junction, taxis are
$7 per person; $1 for ·each additional person during the day. A-1 Triple AAA Taxi Company serves the train·
stations. (609) 921-1177. Call in advance to arrange service 8 a.m.-10 p.m.
From New York City: NJ Transit trains leave Penn Station every half hour for Princeton from early morning to
late evening. The price is $8 one way to Princeton Junction, $9 if you continue with the Dinky into Princeton train
station; $14 round trip. For other times contact NJ Transit Information at 1(800)772-2222 (for NJ only) or out of
statc;l dial 1(201)460-8444. A few Amtrak trains stop at Princeton JunCtion.
From Princeton Junction: The shuttle train between Princeton Junction and Princeton is called the Dinky. It meets
all NJ Transit trains. The trip takes 5 minutes, and cost is $1 one-way/$2 round trip if bought separately from the
NYC-Princeton trip. Amtrak does not coordinate its schedule with the Dinky and does not sell tickets for the
·
Dinky. They can be purchased on the Dinky.
.
.
To reach the Nassau Inn: From the Princeton "Dinky" train ~ta:tion, walk 10-15 minutes up university Place to
Nassau Street and then right to Palmer Square. Cabs may be available at the Dinky. Phone (609) 924-1222.
BY CAR
From the North (New York): NJ Turnpike to Exit 9. On exiting tollbooth, get into righthand lane and stay there.
Join Route 18 going north toward New Brunswick. The road swings around to the left and then swings to the right
with the exit to Trenton off the righthand lane. Follow the signs to U.S. Route #1, Trenton, South. Princeton is
approximately 15 miles south. Tum right on Washington Road, a major intersection with 3 gas stations. The
University is about one mile ahead. The Woodrow Wils0n School is located at the comer of Prospect and
Washington (second traffic light). The Nassau Inn is off Nassau Street in downtown Princeton .. At the intersection
of Washington and Nassau Street (third light), tum left, continue through one traffic light, and then right at Palmer
Square.
From the South <Washington, Philadelphia, Trenton): Take I-95 north. Shortly after crossing the Delaware River
above Trenton, I-95 north becomes I-295 south. At U.S. Route 206, exit east to Lawrenceville and Princeton.
Follow Route 206 to Princeton. When Route 206 in Princeton turns north to Somerville, continue on Nassau Street
(NJ Route 27) to the University .. Palmer Square will be on your left and at the second light (Washington Road)
make a right. At the first light on Washington Road make a left; _the Woodrow Wilson School is on the comer of
Washington Road and Prospect Street.
TO AND FROM AIRPORTS
Newark Airport: This is the closest airport. Mini-bus Limousine service is provided to and from the Nassau Inn
by Princeton Airporter (609-587-6600). Arrangements must be made in advance. Upon arrival at Newark Airport,
report to the limousine service desk in arrival areas. Cost is about $18. Custom Limousine service is available
from A-1 Limousine (609-951-0070). ·cost is about $64 not including tolls and gratuities and must be arranged in
advance.
Philadelphia Airport: Depending on flight connections, this may be as convenient as Newark Airport to Princeton.
Princeton Airporter also provides direct services to the Nas8au Inn. Upon arriving, report to the limousine service
desk in arrival areas at the baggage claim level courtesy phone. The cost by mini-bus is $29 per person.
Arrangements must be made in advance by calling Princeton Airporter (609-587-6600). Custom limousine service
is available from A-1 Limousine (609-951-0070). Cost is about $105 not including tolls and gratuities and must
be arranged in advance. .
.
.
March 15, 1994
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Main Campus Directory
PRINCETON UNIVERSITY
Alexander, E2
Architectural Lab, I7
Architecture, School of, G3
Armory, I6
Art Museum, F3
Baker Rink, F6
Bendheim, H3
Blair, E3
Boathouse, H9
Bowen, J3
Brown, F4
Burr,H2
-Butler Apartments, L7
Caldwell Field House, J6
Campbell, E2
Chancellor GreenCenter, F2
Chapel, G2
Clapp, G5
Class of 1901, E4
Class of 1903, F4
Class of 1904-Henry, E4
Class of 1905-Foulke, E3
Class of 1915, F5
Class of 1922, G5
Class of 1927 -Clapp, G5
Class of 1937, G4
.Class of 1938, G5
Class of 1939, G5 .
Class of 1940, G5
Class of 1941, G5
Class of 1942, F5
Clio, F3
Computer Science, 12
Computing Center, K4
Corwin, H3
Cuyler, F4
DeNunzio Pool, J7
Dickinson, G3
Dickinson Street
Housing, D3
Dillon Gymnasium, F4
Dinky (train station), E5
Dod, F3
Dodge-Osborn, G5
East Pyne, F2
Edwards, F3
1879, H3
Elementary Particles
Labs, K7
Energy Research Lab, J2
Engineering Quadrangle, J2
Eno, G5
Feinberg, G4
Fine, H5
Firestone Library, G2
Fisher, H3
FitzRandolph
Observatory, X6
Forbes College, D6
48 University Place, E3
Foulke, E3
Frick, H3
Gauss, F5
Graduate College (residential
and dining complex), B6
Green, H2
Guyot, H4
Hamilton, E2
Henry, E4
Henry House, F2
Hibben Apartments, G9
Holder, E2
Hoyt, H2
Jadwin Gymnasium, J7
Jadwin Hall, H5
Jewish Life, Center for, H4
Joline, E2
Jones, G4
Laughlin, E3
Lenz Tennis Center, G7
Little, E3
Lockhart, E3
Lourie-Love, G5
Lowrie House, A2
Maclean House, F2
MacMiilan, F6
Madison, E2
Magie Apartments,.G9
Marx, G3
McCarter Theatre, E5
McCormick, F3
McCosh, G3
McCosh Health Center, G4
Mestres (Madison); E2
Moffett, H5
Mudd Library, I3
· Murray-Dodge, F3
Nassau Hall, F2
New South, E5
1912 Pavilion, H6
Notestein, H4
185 Nassau Street, H2
171 Broadmead, L5
116 Prospect, K3
Palmer, G4
Palmer House, D 1
Palmer Stadium, I5
Parking Garage, J3
Patton,F4
Peyton, I5
Princeton University
Press, I2
Prospect House and
Gardens, G3
Pyne, E4 _
Robertson, H3
Rock Magnetism Lab, G5
Schultz, H5
70 Washington Rd., H4
Spelman Halls, E5
Stanhope, F2
Stevenson Halls, J4
Tennis Pavilion, F5
Third World Center, J3
Thomas, H5
Train station (Dinky), E5
University Store, E3
Von Neumann, K3
Walker, F4
West College, F2
Whig, F3
Wilcox, G5
Witherspoon, E3
Woolworth, G3
Wu,F5
Wyman House, B6
Undergraduate
Residential Colleges
BUTLER COLLEGE
Class of 1915, F5
Class of 1922, G5
Class of 1940, G5
Class of 1941, G5
Class of 1942, F5
Lourie-Love, G5
Patton,F4
Wu,F5
FORBES COLLEGE
D6
MATHEY COLLEGE
Blair, E3
Campbell, E2
Hamilton, E2
Joline, E2
ROCKEFELLER
COLLEGE
Blair, E3
Holder, E2
Madison, E2
Witherspoon, E3
WILSON COLLEGE
Class of 1927-Clapp, G5
Class of 1937, G4
Class of 1938, G5
Class of 1939, G5
Dodge-Osborn, G5
Feinberg, G4
Gauss, F5
Walker, F4
Wilcox, G5
Graduate College
Residential and dining
complex, B6
Wyman House, B6
Eatin·g Clubs
Campus Club, H3
Cap & Gown Club, J4
Charter Club, J4
Cloister Club, J4
Colonial Club, I3
Cottage Club, I4
DEC (Dial/Elm), I3
Ivy, I3
Quadrangle Club, I4
Terrace Club, H4
Tiger Inn, I3
Tower Club, H4
2/15/93
Admission: undergraduate, West College, F2; graduate,
Nassau Hall, F2
·
Alumni Council, Maclean House, F2
Archite_cture, School of, G3
Art Museum, F3
Athletic event ticket office, Jadwin Gym, J7
Auditoriums: Betts, School of Architecture, G3; Dodds, Robertson
Hall, H3; Helm, 50 McCosh Hall, G3; Richardson, Alexander
Hall, E2; Taplin, Fine Hall, H5; Wood, 10 McCosh Hall, G3
Bookstore, Princeton University Store, E3
Bus tickets, newsstand kiosk, Palmer Square, F1
Career Services, Clio Hall, F3
Center for Human Values, Louis Marx Hall, G3
Community and State Affairs, Nassau Hall, F2
Daily Princetonian, 48 University Place, E3
Dean: of Admission, West College, F2; of the Chapel, MurrayDodge Hall, F3; of the College, West College, F2; of the
Faculty, Nassau Hall, F2; of the Graduate School, Nassau Hall,
F2; of Students, West College, F2
Engineering and Applied Science, School of, J2
Exhibits: Art Museum, F3; Firestone Library, G2; Mudd Library,
13; Natural History Museum, Guyot Hall, H4
Financial aid, undergraduate, West College, F2
Food, phones, rest rooms: Chancellor Green Center, F2
Gardens, Prospect, G3
Gymnasiums: Dillon, F4; Jadwin, J7
Housing Office, Macmillan Building, F6
Infirmary, McCosh Health Center, G4
Information: Communications/Publications, Stanhope Hall;
Public Safety, Stanhope Hall, F2
International Center, Murray-Dodge Hall, F3
Jewish Life, Center for, H4
Library, Firestone, G2
_
Limousine (to Newark Airport), Nassau Inn, Palmer Square, Fl
Lost and· found, Public Safety, Stanhope Hall, F2
Parking: visitor, lot 16, F7 (campus shuttle stop); parking
information, Public Safety, Stanhope Hall, F2
President, Nassau Hall, F2
Princeton Alumni Weekly, 194 Nassau Street, 11
Princeton Materials Institute, Bowen Hall, J3
Princeton Weekly Bulletin (and calendar of events),
Communications/Publications, Stanhope Hall, F2
Prospect House, G3
Provost, Nassau Hall, F2
Registrar, West College, F2
Rest rooms: Chancellor Green Center, F2; Stanhope Hall, F2
Security, Public Safety, Stanhope Hall, F2
Snack bar, Chancellor Green Center, F2
Taxi stand, Nassau Street, Fl
Telephones: Chancellor Green Center, F2; Nassau Street, F1;
Stanhope Hall, F2
Theater: Intime, Murray-Dodge Hall, F3; McCarter, E5
Third World Center, J3
Tours, Orange-Ke·y Guide Service, Maclean House, F2
Train station (Dinky), E5
Treasurer, New South·, E5
Women's Center, Burr Han; H2
Woodrow Wilson School of Public and International Affairs,
Robertson Hall, H3
Princeton University operator: (609) 258-3000
Emergency: 258-3333
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Robertson Hall
Princeton University
Princeton, New Jersey 08544-1013
P:Trinity
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Ms. Carol Rasco
Assistant to the President
for Domestic Policy
The Whlte House
1600 Pennsylvania Avenue
Washington, DC 20500 .
�U.S. Department of Justice
Office of the Associate Attorney General
The purpose of the conference is to provide a forum tohear
selected tribal r~presentatives discuss specific issues arising
under both Departments authority, including law enforcement,
natural resources, 'gaming, status of tribal governments, youth
intervention and free exercise of religion. In the interest of
having a useful exchange of ideas, we plan tohave a federal
official seated at each table in order to hear from as many
tribal leaders as possible.
Please call 1-800 733-9107 to inform us whether you will be
attending the conference.
Attachments
�ACCOMMODATIONS
.!d
Early hotel reservations for this meeting are
vital. You must make reservations NO LATER
THAN MARCH 30th to be assured of getting
Hotel
a room at the conference rate.
accommodations are scarce in Albuquerque on
the conference dates so there is no guarantee
you will get a room unless you make your
reservations by March 30th.
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The registration deadline for the National
American Indian Listening Conference is
MARCH 23, 1994. There is no fee required for
conference attendance. Participation in the
Conference discussions will be limited to tribal
leaders.
The Departments of Justice and Interior have
made arrangements with the American Indian
Law Center, Inc., located at the University of
New Mexico in Albuquerque, to receive the
registration forms. Please complete both sides
of the attached registration form and return it
H.) the American Indian Law Center in the
enclosed self-addressed, stamped envelope as
soon as possible.
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Amberly Suites
800!333-9806
$60/single $70/double tax incl. (TA/FP/CB)
z
CONFERENCE
The National American Indian Listening
Conference will take place at the Albuquerque
Convention Center, in downtown Albuquerque, New Mexico, on May 5th & 6th, 1994. A
welcoming for tribal leaders, their staff and
guests, visiting members of the Clinton Administration, and elected officials will be held the
evening of May 4th.
Information about Albuquerque, along with
the agenda and reading materials, will he
forwarded to you in your registration confirmation package.
Doubletree*
505(247-3344
$60/single $80/double tax incl. (TA)
Hampton Inn
505/344-1555
$50/single or double + tax (FP)
Holiday Inn Pyramid
$79/single $89/double
+
800/465-4329
tax (TA/FP)
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$79/single $80/double tax incl. (TA)
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NATIONAL AMERICAN INDIAN LISTENING CONFERENCE ISSUES
PRIORI1Y
~
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Please prioritize the following preliminary list of Conference issues ( 1
addressed to the Departments of Justice and Interior.
~
= top priority), and add others which might be
ISSUE
Law Enforcement and Criminal Justice
Tribal & Federal Responsibilities for the use & management of tribal land, water, natural resources.
Gaming
Status of Tribal Governments and Tribal Courts
Youth Justice Issues
Native American Free Exercise of Religion Act
Other: ________________________________________________________________
Other:. ______________.;_________________________________________________
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March 28, 1994
PROPOSED FORMAT
THURSDAY, MAY 5, 1994
8:30AM -
OPENING:
Short film: produced for_ the Conference by a Santa Fe
American Indian film maker.
Brief remarks by Attorney General Reno and Secretary of
the Interior Babbitt.
9:30AM12:00PM
SUBSTANTIVE SESSION 1:
Tribal & Federal Responsibility for the Use & Management
of tribal land, water, natural resources;
9:30-10:15:
Small Group Discussions
The Attorney General and the Secretary will listen as
three or four tribal leaders expert in this specific
topic area present a consensus from the Tribes' points of
view on the major concerns, proposals, issues arising
under this general topic.
These participants will be
seated with the Attorney General and Secretary Babbitt at
in a staging area at the front of the convention floor.
The leaders will be selected with input from both Indians
and the federal government for their familiarity with the
designated issues and the ability to articulate the .ideas
arising from the designated issues. Each discussion will
last for forty-five minutes to an hour.
10:15-10:3a: Break
10:30-11:00: Table Caucuses
Following each small group discussion will be table
caucuses where all participants will express their
independent views on the given substantive issue.
8 to
10 tribal leaders will be seated at each round table
organized around the staging area. At each table there
will be one Administration representative with relevant
experience with the topic.
The table discussions will
generate comments and/or questions for the Attorney
General and Secretary Babbitt.
�ij
. :' . .._ ·~.
.
11:00-12:00: Comments from the Floor<
The comments generated through the table caucus will be
presented to the Attorney General and Secretary Babbitt
from floor microphones placed throughout the conference
rooms.
12:00PM1:00PM
WORKING LUNCH
The Attorney General will have a chance to hear the
issues · not
included
in
the
formally
specified
topics.
Cultural Entertainment will be provided for
part of the time.
1:00PM3:00PM
SUBSTANTIVE SESSION 2:
3:00PM-
BREAK
3:15PM5:00PM
SUBSTANTIVE SESSION 3:
Native American Free Exercise of Religion
Status of Tribal Governments and Tribal Courts
FRIDAY, MAY 6, 1994
SECRETARY CISNEROS IS SCHEDULED TO JOIN THE ATTORNEY GENERAL ON THE
6TH. SECRETARY BABBITT IS NOT CURRENTLY SCHEDULED TO BE IN
ALBUQUERQUE ON MAY 6TH.
9:00AM12:00PM
SUBSTANTIVE SESSION 1:
Law Enforcement and Criminal Justice,
Including issues of domestic violence,
delinquency
prevention,
and
drug
treatment· programs.
9:30-10:15:
10:15-10:30:
10:30-11:00:
11:00-12:00:
12:00PM1:00PM
Small Group Discussions
Break
Table Caucuses
Comments from the Floor
WORKING LUNCH
Same as the previous day.
1:OOPM3:00PM
SUBSTANTIVE SESSION 2:
3:00PM-
BREAK
3:15PM5:00PM
SUBSTANTIVE SESSION 3:
5:00PM
CLOSING
Delinquency Prevention Issues
Including issues of domestic violence and
alcohol and drug treatment programs.
Gaming
and
alcohol
�•;;,
TOPIC AREAS FOR THE
SMALL GROUP DISCUSSIONS
I.
Tribal and Federal Responsibility for the Use and Management
of Tribal Land, Water, and Natural. Resources
The federal government has long recognized the role of
states in the regulation of natural resources and the enforcement
of environmental laws.
However, the role of tribes in this
scheme has often been ignored and needs to be addressed.
The
small group discussion will most likely focus on the following
issues: water rights; the scope of tribal control over resources
in Indian Country;
the application of the Endangered Species Act
to Indian Tribes and their treaty·rights; the drafting of
environmental codes for Indian Country; the treatment of tribes
as states by certain pieces of federal legislation; and the
tribal liability over environmental issues.
II.
NAFERA
The Senate has introduced the Native American Free Exercise
of Religion Act which specifies that the federal government
should endeavor to protect sacred sites threatened by federal
land management decisions. Discussion will likely center on
whether the protections of the Act should extend to nonfederally
recognized tribes, whether the protections should be accorded to
tribes or individuals, whether these protections should reach the·
Bureau of Prisons or include Eagle Feathers, and what government
actions are excluded from scrutiny under the Act.
III.
Status of Tribal Governments and Tribal Courts
In phone calls to the tribal leaders, a majority have
selected this topic area as.the first or second most important of
the six identifies.
The discussion will explore the relationship
between the federal and tribal governments, touching upon such
complicated issues as the jurisdictional and other implications
of tribal sovereignty, the application of federal statutes to
tribes, and the role of the feder.al government in protecting the
civil rights of Native Americans'.in Indian Country.
The
discussion will also address the relationship between tribal and
federal courts, facing issues such as the need to strengthen the
tribal courts; the jurisdiction of tribal courts; and the
relationship between the tribal courts and the state and federal
courts.
�IV.
Criminal Justice and Law Enforcement Issues
The crime rate on some Indian land is higher than in this
country's most violent cities. This discussion will focus upon
such issues as the escalation of gang violence and domestic
violence in Indian Country; the need for, and possible shape of;
violence prevention initiatives; the need for drug and alcohol
treatment and prevention programs; the scope of tribal authority
to prosecute crimes in Iridian Country; the impact of the Crime
Bill on Indian Country; the need for improved cooperation,
coordination and communication between tribal and federal law
enforcement; and problems of overlapping jurisdiction and gaps in
jurisdiction.
V.
Delinquency Prevention Issues
This topic area concerns crimes by and against Indian youth.
The discussion will likely concentrat~ on federal policy with
respect to Indian juvenile delinquents and the need to create an
Indian Juvenile Justice System; the pressing problem of increased
gang violence in Indian Country; problems with the current
investigation and prosecution of child abuse case~; and the need
for domestic· violence prevention.
VI.
Gaming
Of all the issues,· this one is probably the most
contentious. Discussion will likely include:
the possibility of
organized crime; the need to create tribal/state compacts
·satisfactory to both parties; gaming as an economic development
issue; the role of the Department of Justice in defending the
Indian Gaming Regulatory Act (IGRA) against lOth and 11th
amendment challenges; and the amendment of the IGRA.
�TEL:
Apr 11.94
16:31 No.004 P.02
..
·,
Monday, April 11 1QQ4
Dear Carol,
ThanKs tor the recent note. 1 had. In Tact, planned to be In Llnle Rock while you were there last
month. Instead 1· spent two days, through five airports, trying to fly froni Atlanta (with BO
dog roo woathor) to Fayottovillo (with 20 inchc:r of :mow). What a wcokl
I am planning to be in Washington for several days at the end of the month. and I hope our luck
In getting together Is better this time. I will be arriving Thursday afternoon (26th) and
returning to Arkan&a& on Sunday afternoon (May 1). I have meetings at NIMH on Saturday April
30 from 0-4 and on Sunday from 0-1:30. Lot mo know if you might havo somo timo. I will be
staying at the Bethesda Marlatt Rasidanca Inn {301-718-0200)
I will be in town to meet wilh the Task Force on Social Work Research-, sponsored by lhe
National Institute of Mental Health. I'm 'excited about the work of the committee and specifically
how social workers can play a moro prominont role in research related to publlo mental health
policy issuas. Funding for rAAAAreh through NIMH hAF: primArily ~:upportAn thA work nf
psychologists and psychiatrists (and others grounded In a clinics/ or medical model approach to
problem ac;se$sment and service recommendations}, with minimal support for· sociologists or·
soci31 workorG who ore grounded in a more community-basad, systems approach to mental
health. I am concerned that an overemphasis on clinical research will provide public
policymakers with a skewed vision of mental health Issues In America. A more balancAd
r~:~tttn:1rch t1y~:tm.h:1 would support both clinical (intrapsychic) and social systems (environmental.
community-based) research. I am strongly advocating for increased reMarch funding which
sp9cifioally targots the problems and options being considered by fodoral. elate and loool
officials, And whieh tAkAF: hoth nllnlcal And systems approach to problem definition,
assessment.resource development and service delivery. NIMH has been very open to these
concern5 and I look forward to working on this Task Force.
i spent a very encouraging day in the Dallas DI-ll-IS offico last w9ok. The meetings concerned IVE
Child Welfare Training funds tor University-Public A(JAney pArtnArF:hipR. · RAr>rAMntatives from
UA Ftlyt:ttl"vill~:t, UALR and DC.FS met with HHS representatives (Leon McGowan. Joe Woodard.
and Charles Yates) to discu&& both financial and program issues. This was the first time lu ttll
my dealings with tho "~ode:~ th3t I have felt wo woro all working together towards a common
ooal. Everyone we talkad to in the Dallas office was more concerned about how to mak9 things
work than how to restrict funding! The atmosphere was conducive to a real partnership
between federal, state and locltl ttytm~o;itl~. Whttl t1 cllttnyel The phrase "It's a new day" came up
ecvcr31 timos. You and others in Washington need to know that the Clinton AdministrationJA
making difference in how government operates. I know you will bo ploacod to know that your
efforts are paying otfl.
a
I lope I get to see in you Washington. If not, I'll try to wrlta more oll~:~n t111d lel yuu know how
things are going "back in tho tronohcr;;". Tako care.
_ _ _ _ I:IQW.BQliLTHEM HOOSIIIII
�TEL:
Apr B.94
16:31 No.004 P.01
.;..:.}
I
A?R ' \ REC'G
u-:\'1\'ERSITY~f..-\RK~'\S . .~S
Ht!ijlii
1
~
!11 Old
Fulbn;lu Colle::• of Aru :anoi Sciences
Dt;mtrnent of Socio]olif
Social Work. Progra::t
fJye~tc,·ille.
~:)in
Arkansas i2701
(:iot > :m.so39
(Svll 575-i981 (F.-'..X)
Telefa.d.Jttile Trd.nsm.l.ttc!ll
t/n/fl!
DatQ
(1/I~L-
TO:
Cov~r
Sheet
,e/15e.e)
COm>ANY:
CITY. a
~~~ ~~-:;..g~
FAX NUMBER:
FROM:
F~~
73e-T"""TL!
NUM3ER
(501)57~-7961
Number of pages
If
~here
6tn-fM&L
in~lutliny
this
(;UV~r::
is a problem receiving t.his
(501)575-5039.
fii.X,
please call
�10:24
N0.233
0)
Ho.~
790 • liwy. 141 North
.Ttmt~.1h<>ru, Ar/t..an.~a.r
72403
FAX J(}J.!).i~-HUSN
501-931·8l188
TO:
~~
carol Rasco
FAX: 202-45 6-287 8
National Health Care Refc:>rrn Task Force
Chris White I KAIT~TV
January 28, 1994
FROM:
DATE:
~(\lA.fl.ttr ,Jj_
\..NV~
~'
Dear Ms. Rasco:
In this letter 1 will attempt to provide you with the information
your office requested during my telephone conversation with them on
January 27th.
On May 7; 1994-{9AM.:530PM} KAIT~TV~ AARP andseverat ·local trealth~
orientated business's -will· hcHft o·ur second .annual Health and
Fitness- Exp·o.
This event will be held at the ASU convocation
Center in Jonesboro, Arkansas and is free to the public.
The Northeast Arkansas and Southeast Miaaouri region .that we can
expect to draw attendance from ha& a population base in excess of
490,000 people. A large percentage of this population are adults
50+.
Ws are intarest&d in arran~ing for a gue~t epeaker to speak to the
parson attending this ev~nt.
·
I am sure you are finding nationally that there are a multitude of
questions regarding Health Care Reform. This is equally true in
Northea~t Arkan5as and Southeast Missouri with Health care Reform
pos~ibly exceedin9 crime as a topic of conversation and questions.
Some of the questions we need answered.are:
1) Are there charges for obtaining a speaker from the Health
care Reform Task Force7 If so, how much?
2)
Are there any specific requirements by the Task Force for
_setting up a town meeting event?
1e:
Minimum space requirements ...
Time requirements
Attendance requirements
security requirements
3)
ls there any specific person we need to coordinate thsss-
efforts with.
Needless to say we would love to obtain Mrs. Clinton ali the
central speaker but feel that having any knowledgeable •peaker who
can inform the public on this very important iilsua woul<1 be
I
wonderful!
·
�01/28/94
q'
10:25
N0.233
...
Carol Rasco
Page Two
. January 28, 1994
I'm truly sorry to have ~ieeed your return call on January 27th and
look forward to the opportunity to talk with you regarding this
matter. Kitty Cherry has said many complimentary things about you
and has assured me that you were the most informed person for me to
contact for information on this matter.
I
appreciate your help in obtaining the afore mentioned
information, If I may, I will attempt to call you Monday January
31, 1994.
Regards,
Chris White
Account Executive
/din
�THE WHITE HOUSE
WASHINGTON
FAX COVER SHEET
OFFICE OF THE ASSISTANT TO THE PRESIDENT FOR DOMESTIC POLICY
SECOND FLOOR, WEST WING
THE WHITE HOUSE
WASHINGTON, DC 20500
(202)456-2216 PHONE
·
(202)456-2878 FAX
TO:~&~(/,~~;..;.;;;....:~..=....;;...~~&~~~F--'
_ ·- - - - - -
FAX #:
·G W
L/85
FROM: CAROL H. RASCO
DATE:
(lh/tJ'I
~;?~------------------------
NUMBER OF PAGES (including cover sheet): __
COMMENTS: ___________________________________________________________
If you have any problems with the fax transmission, please call
at (202)456-2216.
The document accompanying this facsimile transmittal shee~ is
intended only for the use of the individual or entity to whom it
is addressed. This message contains information which may be
privileged, confidential or exempt from disclosure under
applicable law.
If the reader of this message is not the
intended recipient, or the employee or agent responsible for
delivering the message to the intended recipient, you are hereby
notified that any disclosure, dissemination, copying or
distribution, or the taking of any action in reliance on the
contents of this communication is strictly prohibited.
�----
--
- - - - - - - - - - - - - - - -
02/07/94
@001
17:09
***************************
*** ACTIVITY REPORT ***
***************************
TRANSMISSION OK
TX/RX NO.
2981
66485
CONNECTION TEL
CONNECTION ID
START TIME
02/07 17:07
USAGE TIME
01'31
PAGES
RESULT
3
OK
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Carol Rasco - Regrets and Invitations Series
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Regrets and Invitations Series
Date
A point or period of time associated with an event in the lifecycle of the resource
1993-1997
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36308" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763318" target="_blank">National Archives Catalog Description</a>
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S
Description
An account of the resource
Carol Rasco's Regrets and Invitations Series details the numerous requests for Rasco’s participation in and attendance at various events, parties, and speaking engagements, and her regrets primarily due to scheduling conflicts. The records include memos, letters, schedules, itineraries, calendars, and notes.
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
Clinton Presidential Library & Museum
Extent
The size or duration of the resource.
128 folders in 16 boxes
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Carol H. Rasco Regretted Invitations - May '94 & June '94 [6]
Creator
An entity primarily responsible for making the resource
Domestic Policy Council
Carol Rasco
Regrets and Invitations Series
Identifier
An unambiguous reference to the resource within a given context
2010-0198-S
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 173
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/Systematic/2010-0198-S-Regrets-Invitations.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/7763318" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Publisher
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Clinton Presidential Library & Museum
Medium
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Reproduction-Reference
Date Created
Date of creation of the resource.
2/14/2014
Source
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2010-0198-Se-carol-h-rasco-regretted-invitations-may-94-june-94-6
7763318