Friday, February 12, 2010

2/3rds of GCASA's admissions are involved in the criminal justice system

Of the 606 patients admitted to GCASA's Batavia Clinic in 2009 only 31.3% had no involvement in the criminal justice system. That means that 68% or 2/3rds did.

In the Orleans County clinic of the 341 patients admitted in 2009 only 33.9% had no involvement in the criminal justice system which means that 64% did.

The same percentages also occured in the Atwater Community Residence and even higher Criminal justice involvement, 75%, occured in Supportive Living.

What does this mean?

1. Increasingly, treatment is being used concurrently with other criminal justice programs. Is this a good thing? Probably. It costs over $35,000.00 per year to keep a person in State Prison and the person incarcerated cannot work, pay taxes, be available for their children, etc.

2. A great deal of staff time is spent on case coordination and producing documents for criminal justice agencies. This kind of collaborative programming gets good outcomes, but substance abuse agencies, in general, are not reimbursed for this kind of indirect service. This creates a huge burden on substance agencies and counselors. Perhaps GCASA's counselors should bill out their time at $125.00 like the criminal defense attorneys do.

3. GCASA is serving the people whom New York State and the counties are expecting us to serve. As I jokingly tell people, GCASA is not the Betty Ford Clinic. We are not set up to provide celebrity rehab to the Lindsey Lohan's and Brittany Spears and Robert Downey, Jr.s of the world. GCASA is set up to serve your family members, neighbors, co-workers when they get their DWIs, are arrested for possession, and family life turns into a distressful, dysfunctional nightmare.

4. The people whom GCASA serves come with many problems: substance abuse, legal, financial, employment, family, mental health, and health problems. The criminal justice systen is the last stop in our society for people who are socially downwardly mobile and whose functioning requires external supervision. These folks have messed up their lives to the extent that their behavior has become problematic and criminal for other people. GCASA becomes the agency to which these folks turn to put the pieces back together again, and/or get things on a more positive track. As you can imagine, this is a very challenging project. It is not a small thing for 2/3rds of GCASA's patients.

5. The medical model, upon which substance abuse service reimbursement is based, may not be the best way to pay for services which often have a very heavy psychosocial component. The Managed Care Organizations make it clear that they only want to pay for services that are "medically necessary". So many of the services which substance abusers need do not fit neatly into this category. Good substance abuse treatment often goes far beyond problems that could be described as "medically necessary" in the strict sense of the word. The expectations from various stakeholders from various perspectives for substance abuse services often leave counselors in a very conflicted and contradictory position having to respond to multiple agendas often which are working at cross purposes. Is it any wonder that CNN money listed substance abuse counselor as the 13th worst job out of 50 in the United States today?

This is article #5 in a series on 2009 GCASA Admission Data.

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