Sunday, March 02, 2008

Mental Health Providers don't need any more busy work 'training': THEY NEED TO BE PAID

There's a really big problem with the suggestions that the mental health care-givers 'need more training.' That's why I did my PhD. I'm trained; when will the state recognize that? The NC Psychology Licensing Board gets that. Who is NC DHHS to ignore that agency?

When will the North Carolina Psychological Association enter into the fray? Not a peep from them. I can only assume that they want mental health reform to fail.

I am sitting here this Sunday evening writing several PCP's and psychological assessments (you have to have both! for new clients under NC mental health reform). I am typing over 100 words/ minute or this would take me hours instead of 2 hours/ person,.....not counting the time I spent with the clients taking the information or driving to see them.

Yes, that's a PhD, with 7 years post graduate training, grinding out PCP's with their ridiculously repetitive questions which are supposed to be 'person centered' (except that the person doesn't get what they ask for).

You see, it more or less TAKES a PhD to understand the infinitesimal thinking behind these PCP's----for this kind of mind-numbing writing was part of a clinical psychologist's training------the creation of these kinds of documents: what you're going to do with the client; what's wrong with the client; how the client will meet blah blah percent of a behavior and over a period of time extend that behavior into, well, until they don't need any more services!

Remember: there is no pay for the creation of this time-consuming document. NADA.

Here is an example; the initial part of the Person Centered Plan (PCP) is intended to cover this:

"Personal Dialogue/Interview" includes this repetitious information evidently constructed by NC DHHS people with not enough work to do: (under that header, these are the questions):

**What has happened in my life this past year? (Include exciting, fun things as well as challenges and concerns)

**Long Term Goals: (What are the things I want to accomplish in the next year? What are my hopes/dreams for the future?)

**Strengths: (What am I good at doing? What do people admire about me? What are my talents/gifts?)

**Preferences: What is important TO me: (What are the people/activities/things/places that matter to me in everyday life? What don’t I want in my life?)

**Needs: (What would I change about my life? What is not working in my life? What do I need in order to be an active part of my community? What do I need to be healthy and safe?)

**Supports: What is important TO me? (What do others need to know or do to support me best in relationships, in things I like to do, in work or school and ways to stay healthy and safe?)

Do you think there are some more ways to say the same thing, perhaps?

Think that about covers everything? You'd be wrong.

Then you ask all those questions to a person in the family.

Then the mental health person who does the interview and writes the report answer the same questions.

Then you render the Axis V diagnoses of the DSM and on Axis III the ICD 9 diagnoses.

Then you list the symptoms.

Then, with the newest version of 'Attachment D: Service Definitions: Community Support-Adults (MH/SA) Medical Billable Service', template at your desk, you stick in the buzz words like 'symptom monitoring'; list the 'domains'; 'self management of symptoms'; more talk about strengths; 'therapeutic mentoring' ; 'skill building'; 'assistance with skill enhancement or acquisition';' relapse prevention', etc , etc., etc.

No NC DHHS buzz words, no pass to GO.

No buzz words, you get a letter from the Quality Management person at the LME or the clinical director who indicates you need to go through 'some more training' in order to create the paperwork w/ the buzzwords in the right places.

And you get no authorization and you go back to the PCP and re-create it until you get it right.

Its amazing there are ANY mental health workers left in NC.

What would be my suggestion as a mental health professional with a doctoral degree in clinical psychology, 12 years of professional experience, one internship, one post-doc year, years of experience of creating psychological assessments?

You might start by having some of the well-trained professionals create the form, for starters. I can assure you it would be a honed-down form covering the basics and there would be no busy-work created by non practitioners within NC DHHS.

In a nutshell, the governor took the millions of dollars which was to have been used for the creation of the scaffolding of mental health reform, paid some other bills, hired some cozy consultants for close to a million dollars when the thing was going down the tubes, then said that the former secretary had not been behind mental health reform, which was of course a lie, and then fled to a fallout shelter whilst avoiding the sad parade of perturbed, saddened, and hopping mad, citizens and providers.

Marsha V. Hammond, PhD


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