Tuesday, April 14, 2009

Working Differently in the Mental Health World: What Does It Mean?

A couple of posts last week dealt with closures of offices, and reduction in staff at various locations around the Commonwealth.  While these changes are happening in the context of a generalized economic downturn with a simultaneous drop in State revenues (aka The Great Recession), they may not simply represent a decline in State revenue.  Perhaps, it is the beginning of the realignment of services needed to deliver on the promise of Rosie D, in the context of the a practice environment in which we don't have enough providers to go around.  In that context:
  • Smart organizations are going to need to realign their resources to be able to provide home-based services in a wraparound model.  It makes sense to close satellite offices when we are about to open up CSAs and the provide much service "in the home".  
  • The finding in the Rosie D case requires us to focus attention on the "high-intensity, high need" kids for a while, and, without additional mental health providers, that will require agencies to focus on those services, probably at the expense of those not so severely affected.
  • Re-training people to do wraparound means that there will be fewer "boots on the ground" while we are getting things in place.  That will look like things are getting worse for a while;  our hope is that they get better.
All of this is not to excuse low rates and the administrative snafus that interfere with the provision of mental health services to children.  It does mean, however, that we need to acknowledge that change carries with it a certain cost in "activation energy", and that that cost is not nothing.  We need to hope that, at the end of it all, we are doing things better.  So, as we hear of the changes in the system, think hard with our agency partners about how from the chaos of our current system we can build a system that allows up to effectively address the needs of those that we have been unable to serve in the past.  We need to break down the silos to build up the systems, and the acting of breaking silos is painful.  

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