Behavioral Healthcare - Blogs

Discrimination on the other side of the desk: Impact of disability and minority status on the conduct of psychotherapy.

Thu, 29 Oct 2009 10:55:34 EST

With the exception ofsome people who used wheelchairs for locomotion or were in recovery, I haven’t worked with many therapists who have had disabilities that I knew about. We recently had a job applicant who was blind and I was wondering if any readers have had any experience employing psychotherapists that are blind or visually impaired. What sort of accommodations did you make, if any, and was there ever any reaction from patients? I have generally assumed that vision was not necessarily a bona fide occupational qualification requirement for a therapist position, although since a lot of information is communicated non-verbally, I wonder if this has been investigated or legally determined. Many years ago, when I was back in training as a school psychologist, one of our classmates had been severely burned as a youngster and, despite reconstructive surgery, still showed significant disfigurement from scarring. I wondered at the time how this might effect her ability to conduct psychological testing with school children. Was it fair to the kids to have this distraction, and, equally, was it fair for her to be excluded from her chosen profession? Even more controversial, perhaps, is when, in a government-funded setting, a patient or client wants to change therapists because of a therapist’s age, gender, race, sexual preference, or disability. How is this to be decided and what issues and whose rights should take precedence? It gets really convoluted when there are cases with more than one disability present, like when the person with the emotional support dog came into our transitional employment bookstore and plopped the dog in front of a disabled worker, who had health problems and severe allergies to dogs. In this case of dueling disabilities, who was discriminating against whom?

Managing your organization on a reduced budget: The worst might be yet to come

Wed, 21 Oct 2009 14:18:33 EST

If you’ve made it this far through the recession without budget, staff, or service reductions, and you think the worst is over, think again. I think this is the time for the behavioral healthcare field to make some hard decisions. Why? Stimulus dollars which have helped stabilize behavioral healthcare funding will not remain in place for very long. Of course, at some point the economy will recover and tax revenue will go up, but we don’t know when that might happen, or what that money will go towards. Will it go to schools and prisons, instead of health care? We don’t know. Now is the time to take an objective look at your business and make tougher decisions while you have more working capital, rather than later, when your back is against the wall. If you’ve avoided making service reductions, you most likely will have to in the second half of 2010, and if you have already made reductions or staff cuts, more may be necessary. Now is the time to think strategically, plan ahead, and make tough decisions. These decisions are going to be difficult, but vital to survival when budgets dwindle. You need to evaluate your profit and loss in various component departments. Those departments that are less profitable may have to be reduced or eliminated altogether. This is where the hard decisions come in; even if you feel these are important programs, you can not continue to support them if they are running a deficit on your reduced budget. Ultimately, you jeopardize everything by running deficits and not having enough working capital to cover your operating needs. Another option would be to reduce administrative costs. However, this may not be a possibility for you, as the administrative burden probably won’t go down much, but you might need fewer employees at this point, which would allow you to make some reductions. I always think mergers, acquisitions, partnerships or joint ventures are good things to consider because that often allows you to pool resources, especially on the administrative side. Being a little larger will allow you to level out resources, and get things done with less overhead. The bottom line is you need to reposition yourself now. You need to do some things immediately and then, more strategically, figure out where you are going to be in a year or even a year and a half.

Delivering recovery-based services in a medical model funding environment: can the round peg fit into the square hole?

Tue, 06 Oct 2009 15:30:40 EST

I’m assuming that most of you who are providing community-based care rely heavily on Medicaid funding to help finance services to those with the most acute behavioral health disorders. For years now, federal and state behavioral health authorities have urged us toward “transformation (kind of brings to mind the waving of magic wands, doesn’t it?) to recovery-based services. I don’t know of any provider organization that doesn’t embrace the notion of Recovery and the evidence-based practices associated with the philosophy. But I also don’t know of any organization (in this country, at least) that has discovered a way to deliver these services in a manner that meets the medical model requirements of the Medicaid program. Have any of you found workable solutions?

Are President Obama and his advisers mismanaging the healthcare debate

Thu, 01 Oct 2009 13:24:42 EST

Are President Obama and his advisers mismanaging the healthcare debate? Yes - 56.52% No - 43.48% COMMENTS - The media are distorting it. - The times they are a changin...everybody needs to realize this and lend a hand instead of just criticism and kooky retorhic. - all americans should have access to health care, it is no longer a privilege but an absolute necessity. - They are "riding the rapids of change" and yes they are getting wet, but they are still moving forward. - Lets go Mr. President. YOU won the election. The people who voted for you knew (or thought so) where you stood on health care. Are the Dems'' so afraid of the right tht they won''t do the right thing for America???? - What is happening to the public option, the single payer option? And, why do the Replicans have control over this debate. It is astounding. More importantly, where are the American people in this debate. Most of them seem nowhere to be found. - I think the insurance and pharmaceutical lobbyists are using their money and power to coerce many politicians to spew their toxic mantra much to the detriment of the American people. President Obama''s plan is a sound plan and is much better than anything else being touted out there.

Worcester State Hospital Major Training Site

Tue, 22 Sep 2009 08:54:09 EST

For at least the past one hundred years Worcester State Hospital has been a training center in all areas of psychiatric care. This tradition continues with at least 20 different colleges and institutions sending students to Worcester State Hospital during each academic year. With so many people on campus, security at the construction site is particularly important. The site, including Hooper Turret and the Clocktower, is surrounded by chain link fence and no one is admitted without advance planning and a hard ha The foundation is complete and soon the steel girders will be moving upwards. Everyone is fascinated to watch the new hospital appear.

Slaughtering Cash Cows: Why are Medicaid Profits not Honored?

Mon, 31 Aug 2009 04:50:03 EST

Like most CMHCs, Medicaid is currently our primary funding source. Under the current reimbursement rate system (for our center) some Medicaid services are profitable (partial hospitalization and case management) , others are break even (outpatient therapy), and some constitute a significant fiscal loss (psychiatric services). We recycle all of our profits from serving Medicaid clients back in to the system to help pay for the Medicaid services that are financial losers and to help serve the uninsured. This fund-shifting is for some reason seen as something suspicious and to be eliminated. Under the banner of “Medicaid funds only for Medicaid patients” our state and federal authorities seem determined to minimize these profits, so that there is nothing or little to recycle and support charity care in the future. In our state charity care ratios for CMCHs average about 18% or revenue and our center has had rates averaging over 30% for the past decade. All of our state funds are tied up in paying Medicaid match or supplementing inadequate Medicaid rates or paying for services to Medicaid clients that are not covered (residential, vocational, etc.) . My only two points are: If Medicaid wants to reduce fund shifting, they need to pay rates that are remotely realistic in regard to the current market, for all services. Why should the state or feds care what we do with the profits we fairly earn? Do they ask private doctors what they do with their profits. And if they happened to use them to subsided uninsured patients, why would that be so inappropriate? 25% of the uninsured have a behavioral health issue, why shouldn’t we use the money we earned to support their care.

Curie, Ramstad: Suicide prevention funds "a glaring omission"

Thu, 20 Aug 2009 08:52:51 EST

In a previous blog, I discussed the concern of behavioral health issues and funding being absent from consideration in congressional and executive branch initiatives. Advocates and federal agencies such as SAMHSA have been working hard in Washington to assure that behavioral health is included in the deliberations surrounding health care reform. This blog revisits the issue of behavioral health being absent in the stimulus package passed earlier this year. What brought this to the forefront again is the data out of SAMHSA showing a significant increase in the demand on the national suicide hotline. Much of that demand has been traced to the circumstances many people are facing in these very difficult economic times. SAMHSA also deserves credit for prioritizing this issue and allocating an additional $1 million to suicide prevention efforts. This is not easy during tough budgetary times. Please find below a link to and copy of an op-ed piece, published August 18 in the Minneapolis Star Tribune, that I co-authored with our good friend, former Congressman Jim Ramstad. We both believe that if we address suicide openly as a public health issue, we will be able to address the discrimination that exists because of stigma and open more avenues for people who need care, treatment and support. http://www.startribune.com/opinion/commentary/53175612.html?page=1&c=y

Inundated with information

Tue, 18 Aug 2009 10:01:02 EST

In the Afterword, author Malcolm Gladwell notes a common theme in his national bestseller, Blink: “We live in a world saturated with information. We have virtually unlimited amounts of information at our fingertips at all times, and we’re well versed in arguments about the dangers of not knowing enough and not doing our homework. But I have sensed enormous frustration with the unexpected costs of knowing too much, of being inundated with information. We have come to confuse information with understanding.” Blink is interesting in that it makes precisely this point. Decision-makers sometimes become paralyzed when decisions focus on every possible outcome, every legal consequence and a dedication to being able to defend their decision. This is true, even in the face of the obvious—when the “right” decision is inherent or known. In one example, he details the imprecision by which emergency room physicians could diagnosis a heart attack. Because of liability, and the sheer number of medical factors, physicians were often cautious in their diagnosis—resulting in expensive treatment for patients that were not having a heart attack. Gladwell then compares this to an algorithm created by Lee Goldman that uses a decision-tree based on only three factors that easily out-performed the physicians that had access to all of the medical and patient information. Although the book is subtitled, “The Power of Thinking Without Thinking,” neither Gladwell nor myself is suggesting that decision-makers make rush decisions based entirely on a “gut-feeling.” Rather, the idea is that there is a point of diminishing return and confusion that needs to balanced with understanding the heart of the problem. Sometimes less is more; sometimes a few simple answers are better than every other possible explanation.

Mergers, CEO Retirements, and Succession Planning: What’s the Relationship?

Mon, 03 Aug 2009 18:52:41 EST

A colleague recently pointed out to me how often mergers in behavioral healthcare organizations follow the retirement of CEOs with significant longevity. I was wondering why this might happen and came up with my own short list of possible reasons: For those less cynical than me, perhaps it is simply coincidental. The upcoming retirement of a CEO, who significantly influenced an organization, made the board and organization carefully reevaluate the organization’s needs for the future. Merger was being considered for some time and the retirement of the CEO cleared the decks for this to take place. When is a better time for this to occur? The board did not have a succession plan they feel comfortable with and merger was an alternative. The CEO did not have confidence in her/his subordinates and wanted to leave the organization in the hands of a trusted peer instead. Merger was a way to ram up and insure a substantial golden parachute for the retiring CEO. I have seen CEOs in the past who have great ambivalence regarding retirement and a merger might offer some way to stay connected to the organization as an emeritus consultant. This may be an excellent way for an organization to utilize the CEO’s experience and expertise. I also remember one CEO who stepped down and became a therapist/program manager in his own center. His presence was somewhat intimidating for the new CEO, who always seem to be anticipating the second guessing of all his decisions. A colleague of mine said that even the Romans could only afford one Caesar at a time. It was much like the university president I met who stepped down and went back to teaching and being a department chair. I’m sure there must many other possibilities that readers can suggest.

Foundations: A good or bad idea?

Mon, 03 Aug 2009 14:02:30 EST

There continues to be a variety of debates on whether nonprofit organizations should have an independent nonprofit 501C-3 to raise philanthropic dollars in support of their mission. Many non-profit boards and executives believe that a separate corporation is just too much administration overhead or bureaucracy; others argue that it provides the focus and attention from the separate board members to raise money independent of the operations nonprofit. I have always believed that an independent Foundation is also an important strategy to protect the donated or “endowed dollars” from the operations which is often times a more risky business. An alternative to this strategy would be for a nonprofit to partner with a community foundation in their area. These independent community foundations can invest the nonprofits money in a cost effective manner with very little administrative charges. In either case, the nonprofit board and executive should look at the real reason to have another nonprofit board for fundraising. A Foundation is just another important strategy, good or bad, it is not the goal! The goal might be to protect the donated assets or to hold buildings with mortgages. Through effective planning, board members and executives can make the most effective decision for their organization’s mission and vision.