Thursday, October 22, 2009

Observations and thoughts from the front lines

Having lost 3 of 6 counselors in GCASA'a Albion office I have been helping out doing evaluations. I have done 10 in the last 2 weeks and it is an enlightening experience. I want to capture and share some of my experience.

1. The paperwork is overwhelming. A great deal of it is unnecessary and amounts to checking boxes and collecting data and filling in boxes that have nothing to do with the client's primary concerns nor does it help in establishing therapeutic rapport or obtaining good outcomes. The paperwork has been promulgated in response to regulatory requirements and reimbursement mechanisms not good clinical practice. Regulatory have no good means of measuring good treatment and good outcomes and so they rely on compliance with paperwork completion as a proxy for good treatment. This is a false assumption, and a dangerous way of evaluating good care. Staff are constantly harassed to treat the medical record not the client and the acknowledgement and recognition of good programs depends on compliance with paperwork requirements not the interaction and service provision to clients.

2. As stated in #1, good treatment is determined by correct completion and compliance of paperwork not client satisfaction or good treatment outcomes. Unfortunately, this has perverted the system of care and the primary customer of service has become the regulator and the payer not the client.

3. It has been impressed on me once again that self destructive behavior should not be equated with criminal behavior. Most of the clients I evaluated were sent by the criminal justice system or other governmental bodies such as the Department of Social Services, the Department of Motor Vehicles, Probation, the courts, etc. The health care system for substance abuse disorders has been captured by government to coerce behaviors which government has determined is in its own best interest and not necessarily in the individual's. What Michel Foucault calls "governmentality" increasingly deprives individuals from their freedom. There is a fine line between whether agencies like GCASA are health care agencies whose mission is to help individuals improve their health or coercive agents of social control. It looks to me like 75% of GCASA's services are designed to exert social control and the client's right to self determination is marginalized if respected at all.

I have further observations and thoughts which I will share in future posts.

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