Please click on link to my blogpost on www.counseling.org.
http://happy-birthday-to-you-ada-americans-with-disabilities-act
Sunday, August 8, 2010
Saturday, July 10, 2010
The Assembly Line Transformation
Imagine a cartoon of three slides: The first slide is a line of clients in an outpatient office waiting to be seen by a clinician on a Friday. The second slide is the clinician trying to focus but is showing signs of fatigue by yawning and looking at the clock. The last slide is the client leaving the office and the clinician swimming in gold bag of green dollars bills. Read on...
A new trend of how to make money in outpatient counseling services is upon us. Despite new laws to reform mental health services for children in Massachusetts, some agencies and entities are still facing financial losses serving clients on Mass Health. In order to stay afloat, some of these for-profit and non-profit entities are using "carrots" with clinicians to keep their doors open. The new gimmick is to offer financial rewards, for example, $ 500.00 for those clinicians who see a certain number of clients a week, 30-40 for a certain period of time. Honestly, this new incentive is enticing and rewarding, but it is really so?
In my professional opinion, I believe that the quality of offering compassionate and caring services can be difficult to establish on this "new assembly line" business model. I remember the old days when clincians earn decent salaries for seeing 16-20 clients a week which was not so long ago. This caseload is much more manageable for clinicans to have time to do their paperwork properly, take care of their own mental health needs during the day, and most of all, establish healthy workable relationships with their clients.
I ponder the following questions on this new business model:
1) How can clinicians establish quality relationship with their clients if a bag of gold awaits them in the new future?
2)How do you prevent burnout? The answer that scheduling 35 clients a week is not an acceptable answer though it is a cold reality on how to accomplish seeing 30 clients a week.
3) How do you prevent possible unethical behaviors such as fraudlent billing? For example, seeing clients for a half hour and then billing an hour for services?
Isn't time for a healthy dialogue to be established with national associations for social workers and counselors to see this new business model is feasible?
How about clinicians learning how to lobby their legislators to change the way counseling agencies are reimbursed by Medicaid? Please note that agencies don't get paid for no-shows for medicaid clients.
What do you think?
Robbin Miller, LMHC
Facilitator
A new trend of how to make money in outpatient counseling services is upon us. Despite new laws to reform mental health services for children in Massachusetts, some agencies and entities are still facing financial losses serving clients on Mass Health. In order to stay afloat, some of these for-profit and non-profit entities are using "carrots" with clinicians to keep their doors open. The new gimmick is to offer financial rewards, for example, $ 500.00 for those clinicians who see a certain number of clients a week, 30-40 for a certain period of time. Honestly, this new incentive is enticing and rewarding, but it is really so?
In my professional opinion, I believe that the quality of offering compassionate and caring services can be difficult to establish on this "new assembly line" business model. I remember the old days when clincians earn decent salaries for seeing 16-20 clients a week which was not so long ago. This caseload is much more manageable for clinicans to have time to do their paperwork properly, take care of their own mental health needs during the day, and most of all, establish healthy workable relationships with their clients.
I ponder the following questions on this new business model:
1) How can clinicians establish quality relationship with their clients if a bag of gold awaits them in the new future?
2)How do you prevent burnout? The answer that scheduling 35 clients a week is not an acceptable answer though it is a cold reality on how to accomplish seeing 30 clients a week.
3) How do you prevent possible unethical behaviors such as fraudlent billing? For example, seeing clients for a half hour and then billing an hour for services?
Isn't time for a healthy dialogue to be established with national associations for social workers and counselors to see this new business model is feasible?
How about clinicians learning how to lobby their legislators to change the way counseling agencies are reimbursed by Medicaid? Please note that agencies don't get paid for no-shows for medicaid clients.
What do you think?
Robbin Miller, LMHC
Facilitator
Saturday, June 12, 2010
Mental Health Professionals Deserve Respect and Credit
Remember Rodney Dangerfield's famous quote," I can't get respect." His famous quote can be applied to the mental health professionals in Massachusetts who are under intense pressure to produce or be terminated. Many of my colleagues including myself are being pressured to see a certain number of clients on Medicaid or risk losing our jobs. The new mental health law for children and adolescents have not improved the quality of services as many families are still waiting for intensive mental health services throughout the state as the number on the waiting lists is increasing day by day. Also, many families are waiting weeks for outpatient services for their children as the insurance companies have decreased the number of sessions and rates for this type of service.
How can agencies and organizations retain qualified licensed mental health counselors including social workers if they are being threatened to lose their jobs due to inequitable productivity standards and unhealthy working conditions? The intense pressue is causing many of my colleagues to endure significant health problems such as high pressure; obesity; lack of sleep; and depression and anxiety attacks. How ironic that the helping profession is encountering the similar issues that our clients face on a daily basis in their lives. How can the mental health profession be respected and credible if they can't clean up their own "their house" without interfering in their ability to serve their clients?
We need to have our state organizations that represent both mental health counselors and social workers to conduct a study on the adverse effects on how the new mental health law is affecting the quality of our work. After the study is completed, the Presidents of both organizations need to have a hearing at the State House with the legislators to promote better quality services for our clients and for our clinicians.
Please note it is very difficult to work with a transient population (on Medicaid) that is known for high no-shows; cancellations; and closures every month. Unfortunately, the clinicians get blamed from management who have no idea how frustrating it is to work this clientele. Double-booking is not the answer as some clinicians will see both clients for a half hour each ,and then bill for a full hourly session to keep their numbers up. I do not engage in this type of practice as it is illegal and unethical to do.
What do you think?
Robbin Miller, LMHC
Moderator
How can agencies and organizations retain qualified licensed mental health counselors including social workers if they are being threatened to lose their jobs due to inequitable productivity standards and unhealthy working conditions? The intense pressue is causing many of my colleagues to endure significant health problems such as high pressure; obesity; lack of sleep; and depression and anxiety attacks. How ironic that the helping profession is encountering the similar issues that our clients face on a daily basis in their lives. How can the mental health profession be respected and credible if they can't clean up their own "their house" without interfering in their ability to serve their clients?
We need to have our state organizations that represent both mental health counselors and social workers to conduct a study on the adverse effects on how the new mental health law is affecting the quality of our work. After the study is completed, the Presidents of both organizations need to have a hearing at the State House with the legislators to promote better quality services for our clients and for our clinicians.
Please note it is very difficult to work with a transient population (on Medicaid) that is known for high no-shows; cancellations; and closures every month. Unfortunately, the clinicians get blamed from management who have no idea how frustrating it is to work this clientele. Double-booking is not the answer as some clinicians will see both clients for a half hour each ,and then bill for a full hourly session to keep their numbers up. I do not engage in this type of practice as it is illegal and unethical to do.
What do you think?
Robbin Miller, LMHC
Moderator
Thursday, April 22, 2010
Gauntlet Pests
Below is a letter to the editor I wrote to a blog moderator entitled, "Shrewsburied."
Please see the comments I received for advocating for equal rights for persons with disabilities.
I am asking for the community to support full handicap accessibility for the forthcoming conversion of the Sumner House to a funeral home that will be opening up in June 2010. A member of the Historical Commission inquired about filing a variance (when he met with the Shrewsbury Commission on Disabilities in March 2010) with the Massachusetts Architectural Access Board (AAB)to preserve parts of the Sumner House for historical purposes. The Commission made it clear in their minutes that the funeral home needs to be accessible including a handicap bathroom for the public use.
As in the past, Shrewsbury has an ugly history of preserving historical significance of old buildings at the expense against persons with disabilities. We need the community support to make the funeral home a public place for all to attend. If the funeral home does not become fully handicap accessibility, then it needs to put a big sign in neon color that says, "Persons with Disabilities" are not allowed" as a state entity would recommend to this business owner.
I guarantee that the disability advocates and this state entity and the AAB will not support a variance to be approved.
Robbin Miller
Advocate
Comments:
Robbin is just one more example of the gaunlet of pests you have to run trying to locate a business in this town. It's no wonder we have no commercial tax base to speak of. Why would a business owner subject themselves to this?
Well, I suppose it is the law, but since when is it any of the state/town's business what I do with private property. I can see making sure that it isn't a fire trap or that it is going to fall down on someone's head, but seriously, the handicap accessible laws are dumb. The mirror in the bathroom has to tilt down, that is a goofy one I have seen. These laws exist for the soul purpose of enriching lawyers who file suit.
Robbin, where did you come up with this? Don't you think you owe it to people to find out what's going on before you publicly slander them?
My comments: As you see the above comments are hurtful and people are entitled to their opinions. I did put the source on where I got the above info in a comment before these comments were posted. It is not easy being an advocate for change, but it needs to be put out there for awareness and doing the right thing.
Please see the comments I received for advocating for equal rights for persons with disabilities.
I am asking for the community to support full handicap accessibility for the forthcoming conversion of the Sumner House to a funeral home that will be opening up in June 2010. A member of the Historical Commission inquired about filing a variance (when he met with the Shrewsbury Commission on Disabilities in March 2010) with the Massachusetts Architectural Access Board (AAB)to preserve parts of the Sumner House for historical purposes. The Commission made it clear in their minutes that the funeral home needs to be accessible including a handicap bathroom for the public use.
As in the past, Shrewsbury has an ugly history of preserving historical significance of old buildings at the expense against persons with disabilities. We need the community support to make the funeral home a public place for all to attend. If the funeral home does not become fully handicap accessibility, then it needs to put a big sign in neon color that says, "Persons with Disabilities" are not allowed" as a state entity would recommend to this business owner.
I guarantee that the disability advocates and this state entity and the AAB will not support a variance to be approved.
Robbin Miller
Advocate
Comments:
Robbin is just one more example of the gaunlet of pests you have to run trying to locate a business in this town. It's no wonder we have no commercial tax base to speak of. Why would a business owner subject themselves to this?
Well, I suppose it is the law, but since when is it any of the state/town's business what I do with private property. I can see making sure that it isn't a fire trap or that it is going to fall down on someone's head, but seriously, the handicap accessible laws are dumb. The mirror in the bathroom has to tilt down, that is a goofy one I have seen. These laws exist for the soul purpose of enriching lawyers who file suit.
Robbin, where did you come up with this? Don't you think you owe it to people to find out what's going on before you publicly slander them?
My comments: As you see the above comments are hurtful and people are entitled to their opinions. I did put the source on where I got the above info in a comment before these comments were posted. It is not easy being an advocate for change, but it needs to be put out there for awareness and doing the right thing.
Sunday, March 28, 2010
Childhood Obesity: How can Counselors Help?
Worcester Medicine, a publication by the Worcester District Medical Society, focused on Childhood Obesity for the Mar/April 2010 edition.
According to the current statistics by the Centers for Disease Control on Janauary 22d, 2010, two thirds of adults and one fifth of children are overweight or obese and 20% of youths have abnormal lipid levels (Lebow, 2010, p 18).
As counselors, we are aware of the adverse effects of the poverty that attribute to high obesity levels in our clients such as the high costs and unavailaiblity to buy healthy foods; increase television watching (which commercials promote fat foods toward children) and computer use and addiction; lack of physical space for recreational activities and exercise; and parents/caretakers not being educated on healthy foods preparation for their children.
The medical community in Worcester are taking steps to promote healthy eating for children through the use of different programs in the elementary schools, the communities; and in the doctor's offices. In addition, the State of Massachusetts has launched a new website entitled, "Mass in Motion", www.mass.gov/massinmotion which focuses on healthy eating choices and physical exercise.
What can the counseling profession do to help decrease obesity in our clients?
Here are some suggestions:
Individual/Family: I support physical exercise as a viable option for children and teens to use as a coping skill to decrease their mental health symptoms as part of their treatment plans. I encourage all clients to check with their primary care physician first before engaging in any exercise program. I also ask that families to engage in a physical activity such as going for walks to increase bonding time with their children and/or having a sit down dinner with healthy foods.
Clinic/Agency: Why not have brochures and resources available in the waiting room for families to peruse while they are waiting for us to see them? Counselors can also give out these materials to their clients, if relevant, during the sessions.
Community/State:Is it possible for state chapters from the Social Work; Psychologists, and Mental Health entities to sponsor local programs for their clients and/or training sessions for their colleagues for CEU credit on the above topic? Also, these entities can have their voices heard when their state legislatures want to propose a tax on a candy and soda to decrease consumption use by children. In Masachachusetts, this tax idea has opposition from a few state legislators and the medical community for a variety of reasons.
Federal: National Associations from above can have their voices heard in promoting the government's agenda to decrease obesity and to increase healthier eating and lifestyles for children across the US. Also, the advocacy personnel and/or lobbyists from these entities can meet with Congress to provide their input and ideas as well.
What do you think?
Robbin Miller, LMHC
Facilitator
Resource:
Lebow, R. (2010). How can we lighten a heavy problem? Worcester Medicine:Worcester District Medical Society.
According to the current statistics by the Centers for Disease Control on Janauary 22d, 2010, two thirds of adults and one fifth of children are overweight or obese and 20% of youths have abnormal lipid levels (Lebow, 2010, p 18).
As counselors, we are aware of the adverse effects of the poverty that attribute to high obesity levels in our clients such as the high costs and unavailaiblity to buy healthy foods; increase television watching (which commercials promote fat foods toward children) and computer use and addiction; lack of physical space for recreational activities and exercise; and parents/caretakers not being educated on healthy foods preparation for their children.
The medical community in Worcester are taking steps to promote healthy eating for children through the use of different programs in the elementary schools, the communities; and in the doctor's offices. In addition, the State of Massachusetts has launched a new website entitled, "Mass in Motion", www.mass.gov/massinmotion which focuses on healthy eating choices and physical exercise.
What can the counseling profession do to help decrease obesity in our clients?
Here are some suggestions:
Individual/Family: I support physical exercise as a viable option for children and teens to use as a coping skill to decrease their mental health symptoms as part of their treatment plans. I encourage all clients to check with their primary care physician first before engaging in any exercise program. I also ask that families to engage in a physical activity such as going for walks to increase bonding time with their children and/or having a sit down dinner with healthy foods.
Clinic/Agency: Why not have brochures and resources available in the waiting room for families to peruse while they are waiting for us to see them? Counselors can also give out these materials to their clients, if relevant, during the sessions.
Community/State:Is it possible for state chapters from the Social Work; Psychologists, and Mental Health entities to sponsor local programs for their clients and/or training sessions for their colleagues for CEU credit on the above topic? Also, these entities can have their voices heard when their state legislatures want to propose a tax on a candy and soda to decrease consumption use by children. In Masachachusetts, this tax idea has opposition from a few state legislators and the medical community for a variety of reasons.
Federal: National Associations from above can have their voices heard in promoting the government's agenda to decrease obesity and to increase healthier eating and lifestyles for children across the US. Also, the advocacy personnel and/or lobbyists from these entities can meet with Congress to provide their input and ideas as well.
What do you think?
Robbin Miller, LMHC
Facilitator
Resource:
Lebow, R. (2010). How can we lighten a heavy problem? Worcester Medicine:Worcester District Medical Society.
Subscribe to:
Posts (Atom)