Gap In Services, Adult Mental Health

Until about a week ago, I had no idea that private insurance does not cover case management. I was surprised and baffled to make this discovery.  How can it be?  How does having private insurance negate the possible need for case management? Why are there so many systemic barriers for people with mental illness?

Chapter 35 of our text discusses the "plethora of existing barriers" that make finding, accessing, and qualifying for services close to impossible. It mentions that case managers themselves often have to create services and supports for clients because often what the client needs is nonexistent.

I would imagine that Mental Health Parity should cover something like this.  For people with complicated and persistent mental illness, isn't a case manager necessary to assist in navigating the system?  

The goal of parity is that mental health care should be included and equally covered in health insurance policies.  Up until 1996, when President Clinton signed the first Mental Health Parity Act into law, insurers were legally able to give far less coverage for mental health care than for physical conditions.  The benefits that were offered were often much more expensive and had higher co-pays.  Parity was strongly opposed by insurance companies and businesses.  NAMI, the National Alliance on Mental Illness which was founded in 1979, was paramount in getting the bill passed, in part by organizing a protest across from the White House during Clinton's reelection year.  However, the bill was weak and did not offer true parity.  Legislators were unable to pass anything stronger until Democrats regained control of Congress in 2007.  The latest parity act, called The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equality Act of 2008, was signed by President Bush on October 3, 2008 as part of  the $700 billion Wall Street bailout bill.  This law made it illegal for group health plans to offer mental health benefits that were unequal to medical coverage.  This meant that co-pays, deductibles, inpatient hospital days, and the number of outpatient visits had to be equal to those offered for physical medical reasons.  It did not mean that mental health care was covered in all insurance policies.  And since health insurance in the U.S. has been, until recently, tied to employment, those who are/were unemployed or work in situations where health care is not a benefit are still lacking mental health care if and when it is needed.

Getting back to case management, it seems like it would be useful for many reasons.  Life threatening and complicated physical illnesses require many providers, medications, and treatments.  Couldn't a case worker be the one person creating a container of and connection to all those involved in care?  

Maybe as a future social worker I am just biased.  The real problem is the system is generally too complicated and disjointed.  If the system of health care, mental and otherwise, were just made more simple...well, then there would be less of a need for social workers!

References:

Ritter, J. A. (2013). Social Work Policy Practice, Changing our Community, Nation, and the World. Boston, MA: Pearson. 

Weil, M. (2013). The handbook of community practice. Washington, DC: SAGE.

Restorative Justice in Florida Schools

The discussion on restorative justice in schools gave me a lot of hope.  My own high school years were tumultuous to say the least and I was eventually expelled in my junior year for, get this, absenteeism.  I went to four high schools.  Two here in Maine, one in Florida, and one outside of Boston in Chelsea, Massachusetts.  I was surprised to hear that restorative justice was being used in Florida.  That's the where the high school I got kicked out of was.  Florida seems (or seemed, this was 1993 after all) to have a heavy disciplinary hand.  If I wasn't in school, I wasn't allowed to get my driver's license until I turned 18, which made it difficult to work.  And how does getting kicked out of school for not attending make any sense?  To me as a 16 year old, it kind of seemed like a get out of jail free card.  Don't worry, the story ended well.  I went back to school in Massachusetts and graduated in 1995 after a year out of school and on my own.  I even went to college for a bit and I'm here no, though approaching middle age, a semester away from my BSW and just a few weeks away from finding out if I'll be accepted into grad school next year.  I was not on the "school to prison pipeline", thankfully.  Because of my personal experience, I wanted to find more information about restorative justice in the Florida school system.  

After some considerable digging, I came up short.  Apparently, back in 2010, Escambia County School District received a considerable grant from the Florida Bar Foundation to develop an Alternatives to Zero Tolerance Program.  Unfortunately and despite parent testimonials about the programs efficacy, the school board cancelled the program in October of 2010.  There is no mention of it or other Restorative Justice programs on the school system's website today.  

I dug a bit more though and found that the Miami-Dade school district is working with organizations like Power U Center for Social Change, People Acting for Community Together, and the NAACP to create an alternative to the zero tolerance measures.  

Together, these organizations and the school district have worked together to integrate some of Power U's "Dignity in Schools Model Code of Conduct".  Miami-Dade is committed to reducing suspensions, partnering with community-based organizations to support positive student behavior, and using restorative justice to repair harm and build community.

So I remain hopeful and also realize that change is hard.  Just as Geoffrey Canada discussed in his TED talk, people fear change or more likely fear the failure that may come along with trying something different.

References:

(Please forgive my lack of APA format.  I don't have Hacker with me today and surprisingly, I do not have the format memorized yet.)

http://escambiaschools.net/cms/page_view?d=x&piid=&vpid=1289140475631

http://inweekly.net/wordpress/?p=3265

http://www.restorativejustice.org/RJOB/breaking-floridas-school-to-jail-pipeline-alternative-approaches-to-student-discipline-and-punishment

Baby College

I am a huge This American Life fan.  This radio show, and now podcast, has been on the air since 1995.  Every week they pick a topic and present stories about that topic from around the country.

I remember exactly what I was doing when I first heard episode 364, Going Big.  I was hanging out in my kitchen doing dishes.  FYI, Listening to podcasts makes doing dishes so much more enjoyable.  While scrubbing away, I first heard about Baby College and the Harlem Children's Zone.  In the show's first act, Harlem Renaissance, Geoffrey Canada is interviewed about the origins of these projects.  Geoffrey Canada grew up poor but his life had changed a lot since his youth.  He was now a well educated, upper middle class man.  He saw how his new neighbors as well as he and his wife were absorbing information about developing their children's brains.  He also realized that the parents he was working with in Harlem really had no idea that this information was even out there.  Harlem parents were not trying to develop their children's brains because this information skipped those of a low socioeconomic status.  Geoffrey Canada wanted these poor parents to know what middle class parents already did, and that knowledge may just be the solution to poverty.  Starting with babies, their parents, and brain development.   

"If you can get to a poor child early on, in the first few years of life, even small interventions can have huge effects."

Baby College teaches parents to read to there children daily and how to handle discipline.  If you grew up poor, chances are your parent probably hit you at least a few times, but what may be worse as far as brain development goes, talked to you in a very negative way.  While the middle class kids are getting praised and encouraged, poor children are getting yelled and screamed at, called horrible names, and just generally being discouraged.  Science is showing that the brain reacts to emotional abuse the same way it does to physical abuse. 

Just as abuse is a cycle, so is poverty.  Geoffrey believes that rather than focus on getting the parents out of poverty, we have to focus on saving the children.  Though it seems unfair, the parents seem to get it.  Just the simple act of reading to their children is going give them the skills they need to do well in school.  When the program aired, the first group of third graders "on the conveyer belt" took the state tests.  The children scored above average.  These kids hadn't had the program since birth, so imagine how the next group of third graders will do!

You can listen to the whole episode here.

On January 8th of this year, President Obama announced the first five "Promised Zones" which would be modeled after the Harlem Children's Zone.  From Southeastern Kentucky to L.A., the federal government will offer assistance to these five zones to implement programs like those of HCZ.  In the next three years, 15 more zones will be named.  

For parents: I wanted to share this podcast, Zen Parenting Radio.  To listen go here.  For those of us who grew up with this...poor parenting style, it's often hard to know just how to be a different kind of parent to our children.  It's so easy to fall back to what we are used to.  ZPR has been so helpful for me in looking at my parenting and myself with awareness and learning how to be the parent I want to be.  It may also be beneficial to your clients.  Despite its title, it has nothing to do with Buddhism.  

References:

Adams. C. & Adams. T. (2013, September 30). Are time-outs hurting your child? [Audio Podcast]. Zen parenting radio. Retrieved from http://zenparentingradio.com/195/

Fact sheet: president obama's promise zones initiative. (2014, January, 8). The white house, Office of the press secretary. Retrieved from http://www.whitehouse.gov/the-press-office/2014/01/08/fact-sheet-president-obama-s-promise-zones-initiative

This American Life. (2008, September 26). Going big. (No. 364). [Audio Podcast]. Retrieved from http://www.thisamericanlife.org/radio-archives/episode/364/going-big

Weil. M. (2013). The handbook of community practice. Los Angeles, CA: Sage Publications

  

The Passamaquoddy and Poverty, an Interview

The Passamaquoddy People have inhabited Maine and New Brunswick for over 12,000 years.  Today many live on their reservation lands on Pleasant Point on Passamaquoddy Bay, known as Sipayik (pronounced Zee By Eek), or Indian Township near the St. Croix River.  Both are located in Washington County.  

For my friend, Marie Francis, Sipayik was her home until she was 15 years old and is still home to many of her family members.  As our text states, Indian reservations are persistently poor areas with poverty rates much higher than the general population.  In fact, the poverty rate at Sipayik, as of the 2000 census, was 38.3% with a median household income of $15,956.  Marie believes her mother's household, which consists of three adults, is living on around $12,000 per year.  

Marie didn't know she was poor when she was a child on the reservation.  Poverty was normalized; everyone lived that way.  She remembered always having enough to eat.  Sometimes they borrowed. Horizontal giving was and is a big part of life.  People looked after and took care of each other.  She doesn't remember ever interacting with a social worker as a child but knows that now it is more common than not to receive some kind of social service.  

In 1st grade, Marie was diagnosed with dyslexia by the Maine Indian Education Department, who told her mother "not to expect too much from her."  Marie remembers taking her textbooks home and teaching herself.  Thankfully, her mother knew she was intelligent and fought for her to get a better education.  When Marie was 15, she left Sipayik to attend a private school in Massachusetts.  Since leaving the reservation, she has done well for herself and hasn't needed any social services since.  

Marie was recently published in Dawnland Voices: An Anthology of Indigenous Writing From New England.  Below you will find her poem, Diminished Dreams:

I look upon her,

She holds my answers, my future,

And my heart.

Her wisdom fades with

The crash

Of sand's time.

Her lost words are

Swallowed

By the waves

Of misconceptions.

Her man-made

Chiseled bounds

Keep her from soaring

To her enlightened highs.

Her cries fall deafly

On the horizon

Of onlookers.

Her voice dulls

With oncoming traffic.

Her love of beauty,

Life and death

Is gone.

I stand in wonderment.

I'm one of the few people

On the verge

Of extinction.

I'm melting away in this pot

Of modern-day life.

I cease to hear the songs

Of my past.

I'm chained to my dollar bills.

I scream for my culture,

But only on the inside.

What I am,

What I was,

And what I could be

Is gone.

I stand over the remains

And wonder

What insight she holds.

I'm always struck by what just a little bit of resources, whether they be monetary, education, etc., can do.  Marie believes that increasing work opportunities would make a huge difference.

References:

Eastern Maine Electric Cooperative. (n.d.). The passamaquoddy. In Who we serve. Retrieved from http://www.emec.com/passamaquoddy.aspx

Passamaquoddy Tribe. (n.d.). Culture and history. In Our people. Retrieved from

http://www.passamaquoddy.com/

Senior, S. (2014). Dawnland voices: An anthology of indigenous writing from new england. Nebraska:  University of Nebraska Press.

Passamaquoddy Pleasant Point Reservation. (2014, August 23). Retrieved on October 28, 2014 from

http://en.wikipedia.org/wiki/Passamaquoddy_Pleasant_Point_Reservation

Organizational Culture and Self Care

While reading Weil (2013) this week, I kept coming back to gratitude for the organization I am lucky enough to be placed at this year.  I want to share their culture with you all as a way to spread hope that it is possible to work in an environment that will not suck all the life out of your wide-open, social-working hearts.

Many of you know that I am placed at Cultivating Balance, a relatively new non-profit in South Portland.  Cultivating Balance (CB) aims to improve public health and awareness by providing affordable resources and supports for sustainable self-care and balanced living.

I am the second intern at this organization which is housed inside Art of Awareness (AoA), a group of psychotherapists.  Both organizations are run by my supervisor, Ida O'Donnell.  Each week, I am invited to join AoA's team meeting which always begins with a mindfulness exercise.  This week we did an exercise called 54321 which was created to help people fall back asleep after waking in the middle of the night.  For more specific directions, go here.  We did this exercise as a group, with individuals speaking out about sights, sounds, or sensations as they felt moved to.  Last week we went around the group ringing bells, and the week before we did a breath meditation.  

Mindfulness is the culture of both CB and AoA.  We educate our clients on self-care, and we are also encouraged to take care of ourselves.  Actually, it is more than encouragement; it is expected.  We are not held to quotas or expected to have a massive case-load.  After the mindfulness practice in team meeting, one therapist presents either a case they are struggling with or something else related to work that they want support with.  The team listens to the presenter and offers whatever support, encouragement, or experience they have.  It's really quite amazing to witness this and be a part of it.  

As students, I think we are internalizing a kind of oppression that Erin brought up in her October 12, 2014 blog.  We are expected to overwork ourselves in preparation for joining a helping profession where our peers often burn out and put themselves at risk for serious work-related trauma and anxiety.  How can we care for and support others if we are not doing that for ourselves?  

In hopes of helping reduce the burden and build upon our self-care skills, I thought it would be helpful to offer Balanced Living Assessments (BLA) on campus (a few students also asked for this).  I got the okay from my supervisor, Ida, as well as Leslie in our social work department.  If you are interested in having a BLA, please let me know!  Below you will find more information about BLA's.

Cultivating Balance is now offering FREE comprehensive Balanced Living Assessments, education, and supports. Our assessment process helps individuals and groups by raising their awareness of any need for balance in 9 areas including: 

❖ Rest and Restoring Energy

❖ Food and Body Balance

❖ Physical Activity

❖ Health

❖ Work and Leisure Time

❖ Support and Relationships

 ❖ Coping

❖ Mindfulness

❖ Values & Beliefs 

After completing the assessment, you will have enough information to evaluate the areas you are motivated to improve. You will also begin to explore the supports and resources available to you, including supportive coaching.If you are interested in taking the Balanced Living Assessment or learning more about Cultivating Balance, please contact: Sonya Theriault at (207) 799-1331, ext.135 or cultivatingbalanceforyou@gmail.com

To be clear, there are still moments of stress at my internship as I am sure there will be wherever I go, however, I am learning how to balance that stress out with self care even when I think it is impossible to take the time to do so.  

I'm hopeful that self care and balanced living will become a larger part of the culture of the social work field.

Resources:

Carlson, E. (2014, October 12). Untitled [Web log post]. Retrieved from: http://erinleighadelaide.blogspot.com/

Cultivating Balance (2014, September 25). Facebook post. Retrieved from: https://www.facebook.com/cultivatingbalanceforyou?ref=hl

Weil. M. (2013). The handbook of community practice. Los Angeles, CA: SAGE Publications.

Participatory Budgeting for USM?

"People who make up the elite political, social, technical, and economic strata of a community usually are the ones who determine priorities for municipal spending" (Weil 2013 p, 335).

We here at USM know that is the case when it comes to the Universities' budget.  Who are these people that are making the financial decisions?  What is guiding them?  Why is the president of our university the former CEO of Central Maine Power and how is his experience guiding his decision making in an educational setting?  Why won't he and his colleagues even look at all the work the faculty senate put in creating budget suggestions?

Students and faculty are more than willing to lend their input to figuring out the budget "crisis", unfortunately their ideas seem to have been dismissed.  How might priorities shift if a diverse array of the students, faculty, community members, and administration were involved in the process?  And furthermore, how much would faith in the process increase if participatory budgeting were enacted?

The first participatory budgeting project (PBP) began in Porto Alegre, Brazil in 1989.  Since then PB has been implemented in many cities and municipalities across North America.  Some school districts, colleges, and universities have practiced PB as well.  If USM truly wants to be a "Metropolitan University", maybe PB would be a viable step toward that goal.  

Real Money, Real Power: Participatory Budgeting

From the video above, you can see how participatory budgeting has worked in communities.  It increases community involvement and engagement, invites those who are not normally able to participate in democracy a chance to do so, and clearly empowers community members. What they think truly does matter.  

Here at USM we are currently engaged in budget cuts that no one but the administration seems to have any say in.  Students, faculty and staff are not only stressed out, we feel powerless.  Could PB work in a budget crisis?  Could we put the cuts to a vote?  It's worth a try.  What's happening now doesn't seem to be working.  

References:

Gallagher, N.K. (2014, October 9). Program, faculty cuts at USM headed for vote despite protests. Portland Press Herald. Retrieved from http://www.pressherald.com/2014/10/09/program-faculty-cuts-at-usm-headed-for-vote-despite-protests/

http://www.participatorybudgeting.org/

The Participatory Budgeting Project. (n.d.). History. In Who we are. Retrieved from http://www.participatorybudgeting.org/who-we-are/history/

The Participatory Budgeting Project. (2014, February 24). Real money, real power: Participatory budgeting [Video file]. Retrieved from https://www.youtube.com/watch?v=CSf8NOlqqUY

Weil, M., Reisch, M., & Ohmer, M.L. (2013). The handbook of community pragctice. Washington, DC: Sage. 

Stages of Change and Wicked Social Problems

Dan Kelly's recent blog post sparked this idea of motivation in relation to social issues.  In order to change, we need to want to.  In order to want to, we need to understand that there is a problem.  I would suggest that for a large amount of the social issues I am aware of, the vast majority of the players involved with the issue are either unaware of the problem, or are extremely resistant to accepting that the problem is a problem, or they just feel like they have no control over the problem.  They don't want to change.  They are in the stage of pre-contemplation in the Stages of Change Model.

The Stages of Change is a model that was originally created to work with people engaging in substance abuse, but it has been put to use for many other health-related issues or problem behaviors.  I don't think it is a huge leap to relate the Stages to social issues which often involve the health of humans.

Climate change, racism, capitalism, and the two party system, to just start with a few, are all issues that involve a majority of people in pre-contemplation, in my opinion.  People in pre-contemplation are completely unmotivated.  They have no will to do anything differently.

How do we work with people (societies) in pre-contemplation?    

I don't have an answer to this question.  It's a question that plagues anyone who has a loved one who struggles with substance abuse.  Getting people from pre-contemplation to contemplation is not an easy task, and many attempts are met with resistance.  As far as social movements, many have pit one group against another.  It's us vs. them.  This type of approach will almost always create resistance.  Increasing awareness and education might be the key.  But that brings up other questions:  How do we educate people who don't want to be educated or who believe the information they are receiving is incorrect?  Maybe it all comes back to what the community of Mart found:  Common ground.  If we can figure out what unites us, we can build from there.  

References:

Kelly, D. (2014, October 7). Blog post #5 [Web log post]. Retrieved from http://swo-403dankelly.blogspot.com/2014/10/blog-post-5.html

Manual of Psychiatry. (2010, October 28). Stages of change [Web log post]. Retrieved from http://manualofpsychiatry.com/2010/10/28/stages-of-change/

Singer, J. B. (2009, October 10). Prochaska and DiClemente's Stages of Change Model for Social Workers (Episode 53). [Audio Podcast] Retrieved from http://socialworkpodcast.com/2009/10/prochaska-and-diclementes-stages-of.html