Monday, October 19, 2009

Back in the trenches

We've lost 3 of our 6 counselors in our Albion office for a variety of reasons. The requests for service have escalated and last week we had 25 requests for intakes.

There is no more money. No increase in our county and state funding. No increase in our reimbursements, not in 10 years.

Yes, you've read that right. Not in a decade.

Now the governor is cutting the state budget and how it will affect substance abuse services isn't clear, but it isn't pretty.

So, I'm the kind of executive director who rolls up his shirt sleeves and helps out. Last week I did 8 intakes.

I'm almost 64 years old. I've been in the field 41 years, and I'm back where I started, providing direct services where they are needed most, on the front lines.

I wonder if the commissioner of OASAS can provide the kind of leadership I provide?

No, she is not a substance abuse professional. She wouldn't have a clue.

I wonder if the regional office staff could do what I'm doing?

No, they re making sure the Ts are crossed and the Is are dotted. They are counting beans as if the patient with DTs cares.

At the end of the day, somebody has to do the work - actually see patients. The people who actually do the work, are the lowest paid, the most harassed by the bureaucrats, the ones criminalized by the Medicaid fraud units because the treatment plans didn't get signed in the designated time frames.

As I leave my administrative desk and actually see patients again, I am reminded that something is terribly wrong with our service delivery systems. We have inverted the system so that the most highly paid, the most highly recognized, the most highly rewarded are the ones furthest away from the actual work.

I am enjoying seeing patients, but the budgets and regulatory paperwork is getting behind so I will leave the patients to suffer waiting for care while Albany makes its paperwork demands, and silly meetings have to be attended, and we pretend that the policy makers and the regulators have the really important work to do.

This week I will do both, see patients and work on my paperwork, but I do so with a renewed awareness about what the work really means and the value it really has, something that too many leaders have never known, or forgotten, or maneuvered to get promoted away from to where the real money is and there is alot less stress and pressure, and in some ways, responsibility.

I am taking care of patients again not worrying about corporate compliance. I have been doing God's work, not the work for soulless bureaucrats.

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