Mental Health System & Section 17

         In the last three months, I have started through Shalom House in York County. The particular program I work in is considered supported housing, in that tenants have 24 hour access to staff members (who are trained and licensed to administer medications); however they have full freedom to come and go as they please, and have as much contact with staff as they like (so long as they have visual contact 1x/day).  This is my first employment experience directly in the mental health field, and already, I have learned so much about the intricacies and challenges of providing care for those experiencing mental illness. Each resident has a number of different providers who they are required to see regularly in numerous locations. In addition to round the clock access to staff members, what holds each of these clients accountable for their self care (including employment obligations, appointments with providers and more) is the caseworker. In many cases, family members are unable to serve in this supportive role, and without the link to community that caseworkers provide, it is apparent that many of the clients in this residence would be unstable.

         Having this awareness of the essential work that caseworkers do, in conjunction with what is occurring with Section 17 in Maine, the Weil chapter on the history of the mental health system could not have come at a more appropriate time.  There are two sides to the “case management” argument– one in favor of the service, which accepts that 1.) the mental health system is fragmented and 2.) case management services assist those with mental illness or other serious diagnosis navigate the fragmented system. The opposition to case management services believes that 1.) continuing case management continues support of a fragmented system and 2.) (using language from government officials) case management “fosters dependence.”

         The ruling suggests that case management services be offered only to those diagnosed with schizo-affective disorder and schizophrenia – two illnesses deemed, in the public eye, to be the most ‘severe.’ When attempting to cut government costs, limiting this service to those individuals makes some kind of sense… that is unless you have seen case management in action. It’s easy to say that providing services fosters dependence. It is harder to provide empathy to high service utilizers with whom you have no connection – probably due to the fact that you have experienced an entire life’s worth of privilege. It’s easy to limit services to those diagnosed with schizo-affective disorder and schizophrenia – understanding that yes – those diagnosis by nature, are very severe. It is harder to attempt to live an organized life (attending doctor’s appointments, making phone calls, managing mail etc.) when experiencing the absolute chaos of homeless life.

         At least in the 1960s, at the start of the community mental health movement, when clinical, hospitalized services were diminished, something else was offered – even if it was short-sided and failed. The changes to Section 17 offer nothing but reducing services that are already flawed and fragmented.

         I don’t envy those in legislative positions in any way. However, fiscally motivated change with no first person knowledge of the impact on service recipients is inhumane. What is equally disturbing, is that despite heavy participation and action on this by providers, as Terrie Haggey put it in her write in to the Portland Press Herald, opposition to these changes are continuing to fall on “deaf ears.”

References:

Haggey, T. (2016). Maine voices: Did opposition to DHHS changes to section 17 fall on deaf ears?. Portland Press Herald.

Weil, M., Reisch, M., & Ohmer, M. (2013). The Handbook of Community Practice. 2^nd Edition. Sage.

Wasteland: Reciprocal Art Processes

           As an undergraduate student, I had watched Wasteland through the lens of an environmentalist. I watched with horror as I learned about what was one of the largest garbage and recycling dumps on the planet. We talked about the resiliency of the people, but were more focused on the lack of awareness we shared about large scale dumps, and what it looked like for those living there, particularly in other countries, where recycling was done by hand. The content of the film stayed with me, and last semester, when we watched a similar film in our Human Behavior course about a similar dump in Guatemala, the images came flooding back to me, but again, not through a community art practice lens.

            It was awesome to watch this again, in combination with the community practice content we have learned about in this course. It holds such a different meaning with me now.

            When we talk about engaging in community art projects, leaders (Paula, those involved in Ted Talks, guest speakers, and otherwise) – there is a sense of love and awe among leaders that I’ve noticed as artists and innovators reflect on their practice. Creating art for others and with others does not solely leave the recipients as beneficiaries, but it seems like artists, too, tend to experience unexpected gains from the process as well.

            Vik Muniz seemed like he entered Gramacho with an altruistic vision, and hopes of maintaining an identity at an arm’s distance from “fine art.” Not only did he succeed in his mission, what he took away was life and career altering. As a Brazilian man, entering Gramacho and building relationships with its workers and residents granted him a greater sense of place, and understanding of the culture in which he grew up. The extent of connection that grew with the individuals engaging in his project altered him morally as well. He learned to question not only the content of his work, but also whether or not he had the right to enter this community, and expose certain members to a realm of the world that was previously entirely out of the scope of possibility. Reflecting on the project, it was clear that involvement did more “good than harm” for participants, and that the endeavor forced Muniz to question his identity in positive ways.

            The more I learn about the ties to art in social work and community practice the more I recognize it as a reciprocal process of benefit. Vik Muniz is an extreme scale example of this. Art provides a way for practitioners to reflect on their learning and experiences in a meaningful, sharable, way. Consumers and onlookers of community art can feel appreciation and recognition in this public forum.

            The more I learn about community art practice, the more legitimacy it gains, and the more enthusiastic I feel about giving some of this a try in Portland for personal reflection and public benefit.  

Reflections On The Experience of Teaching & the Ties to Community Practice Social Work

Even though I often talk about my experience as an elementary school teacher, and draw connections from the classroom to the practice of social work, I haven’t genuinely reflected on the experience until last week, when it began to “hit me like a truck.” It wasn’t that I hated teaching, or that I was completely terrible at it - but so many things about it felt so wrong to me, that until very recently, I had found ways to kind of block out the experience. This week, through my community practice social work lens, I finally started to critically evaluate my time as a teacher, and discover what might be my entry points for intervention as a future community social worker in the education field.

What stands out as most egregious to me, are varying styles of discipline between schools. Since leaving the field, and gaining a little bit of distance from teaching, I’ve started to look critically at the models of different schools, and what I think might actually be a good starting place for improvements.

Gardner Pilot Academy (GPA), where I spent my 2.5 years, is technically a Boston Public School, with certain “autonomies” only allotted to Pilot or Charter schools. As a full service school complete with a public health clinic, eye and dental care (periodically), counseling services (via two different providers), two universally provided meals per day, a social worker as vice principal, and highly experienced/dedicated staff - the combination of characteristics sounds like an absolute recipe for success! With the exception of a school wide Positive Behavior Incentive System (PBIS), teachers are granted full autonomy over their disciplinary styles, which again, sounds amazing.

For about a million different reasons tied to systems failures and complications, however, the idyllic school model is far from high achieving. Student behavior at the school is a massive issue - and speaking from experience, in attempts to do the very best I could, absolutely found myself reacting in lieu of thoughtfully responding to challenges. Inconsistencies in expectations and outcomes among staff are huge, making any sort of predictability difficult for kids to navigate day to day and year to year.

While in theory I love the idea and intent behind this specific model, I also know that as is, this model is not working for students, teachers, or administration - people are burning out.

Check out the Gardner Pilot Academy Website

On almost the opposite of the discipline spectrum, is the UP Academy “takeover” organization (also functioning within the BPS). UP schools are highly regarded for their structure, rigid discipline, and increases in test scores post take over. Among urban schools, this model has proven quite effective in working with challenging populations in that it provides consistency throughout an entire school, and universal accountability.

I’ve definitely had misgivings about this sort of model, but have at least tried to stay open - because if it works, who am I to judge.

Interestingly, the latter model just had a scathing article written about it via NPR which revealed some astonishing data around kindergarten suspensions (see below) and the insanity driving some of this discipline.

[Click here to read the NPR Article]

Removing my “teacher hat” and allowing myself to explore school disciplinary models as a social worker - I feel totally ideologically lost. Do I think either are perfect? Absolutely not. But, from a realist perspective, a variation of one or the other is currently used in nearly every urban public elementary school. Just because discipline is a certain way does not mean that it is necessarily right.

I realize that this entire blog post is somewhat of a personal rant, however, I find comfort in having a public space to write about this. Putting on my “community, participatory practice hat,” a reasonable first step in remedying some of the woes of public school discipline might begin with enlisting the help of MANY diverse parents, and students, in creating a “unique to each school” system in addressing the behavioral needs of students. A large sample of parents, students, teachers, and social worker(s) could collaborate to identify behavior expectations and agreed upon restorative practices so that there is more “buy in” from students, and support from parents. It would have to be an ongoing process - each year would require unique and repeated attention to the matter to make sure that the model reflects the current needs of the students, and approval of the families. These kinds of participatory meetings could, and should be administered by school social workers, using participatory practice organizational methods - at least as a starting place.

I’m not entirely sure what this might look like, however, I (and many other teachers) feel a huge sense of exasperation in “business as usual” and know that in regards to both of the earlier mentioned models… we could do better by everyone.

It’s easy to allow myself these creative approaches to discipline while also not faced with the challenge of running a classroom daily, but my sense of reflection is honest, and growing daily as I finally begin to process my experience, this time as a social worker.

Reference:

Weil, M., Reisch, M., & Ohmer, M. (2013). The Handbook of Community Practice. 2nd Edition. Sage.

Are We Done Yet? Never-ending Problem Solving.

I am admittedly very tied to outcomes (personal, individual client’s goal achievement, and group project products). Last semester, in our practice course, when learning about the solution-oriented therapy modality, I immediately latched onto this, thinking , “this makes sense to me - this is a pragmatic approach, there are clear action steps - there is a measurable end in sight.” I still think like this - I can’t help it, but the further I read into the “Social Labs Revolution” the more impractical this thinking becomes, I realize. Even though Dr. G’s saying, “solutions to problems only create new problems” rings through my brain, I’m only just beginning to accept the “ongoing” nature of tackling complex, messy, social issues.

Haisson (2014) articulates this really well when he says, “We have to keep reminding ourselves that such outcomes cannot be theoretically falsifiable in advance. We cannot, in other words, know what new solutions to problems and challenges are before they are created, discovered, or invented; otherwise we would have implemented them already. Where we demand certainty, or falsifiable theory, before we act, we are essentially asking for an elimination of risk and failure. It’s a bit like asking for a guarantee of a great insight, a great discovery, or a great piece of art” (p. 103). I loved this statement - and in order to begin in any sort of social lab or large scale community problem solving - I feel like I need to get this tatoo-ed on my forehead, so that I don’t forget it!

So much of this statement and process goes against instinct - how can we possibly jump into the social problem solving process without any sort of specific hope, quantifiable goal, or predicted practice method? Doing any of the above, however, Haisson argues, runs the risk of resorting to ‘BAU’ (business as usual), and failure to employ real group innovation - the purpose of a social lab.

On one hand, the practical side of me is discouraged - if I am working on a team to address a social issue, in order to feel a sense of completion, I undoubtedly desire an outcome, or sense of success or inability to meet goals. On the other hand, acceptance of the continual nature of this work, and submission to the idea that there are no absolute solutions is oddly liberating (the more times I hear the message, and attempt to digest it).

Bringing together a team of multi-disciplined innovators and planners to tackle a messy issue allows for creativity in practice that might not otherwise be achieved. For this to be most impactful, team members have to accept and adopt a lack of outcome - open to all possibilities - because as Haisson says, if the easy, and positive solution existed, it already would have been implemented.

I’m really starting to grasp the fact that there will never be a shortage of social issues over which to grapple. All progress will have future limitations, but that is not an excuse not to engage in the work and get messy. 

When we talk and debate (in and outside of class) about the duty of social workers to fight for social justice (versus engaging in solely private practice work etc.), it seems to me like social workers deserve a seat in these deliberation groups, and in some ways, it is our duty to find our way into those groups that are of greatest interest to us.

Reference:

Haisson, Z. (2014). The social labs revolution: A new approach to solving our most

complex challenges. San Francisco: Berrett-Koehler Publishers, Inc.

Struggle for Authenticity and the Motivation to Engage in Community Practice

            “Are you an addict?”

            “Are you in recovery?”

            “No I mean… it’s just really interesting that you’re here.”

            “Aren’t you the student?”

            “Why are you interested in substance abuse?”

            “I mean… no offense or anything but… why are you here?”

           

            These are questions and comments that I hear daily at my field placement. In the therapeutic environment with clients, I have learned to respectfully deflect these questions, advised that any sort of boundary defining response serves little to no therapeutic purpose. I’ve practiced, and am slowly improving at this. To be honest, I barely hear these questions, or my responses anymore – but that wasn’t always the case.

            Internally, I was really grappling with my answers to some of these, and in some ways struggling with feelings of group exclusion.  Am I an addict? No! Can I share that with friends? Yes! Is there a personal interest and history with drugs and alcohol? Absolutely. Am I ashamed of the continual presence of alcoholism in my family? Definitely. Repeatedly probed with these questions, by about December, I suffered a genuine loss of self, motivation, and sense of place. “I lost my mojo” – my original desire to work in the substance abuse field – and my insecurity showed.

            Somewhere in there, in confidence with a friend, I finally melt down, and reconnected with my passion in this field. There is enough of a “heart-tug” connection to the work (in relation to my father, and other people I love), and genuine interest in the impacts and treatments of drugs and alcohol (both of which I no longer feel obligated or compelled to shout off the rooftops as justification to anyone who asks), that following my meltdown, I felt like I recognized my own authenticity – my own sense of place – and got comfortable.

            It was after this internal resolution that my connection with clients professionally deepened, that I gained the comfort that comes with a little time an experience in any setting.

            The more I’ve learned about substance abuse, and specifically treatment, in Maine, the more glaringly apparent the social injustices in the field become. Specifically, looking at things through a critical feminist lens, the staggering difference between the numbers of male versus female treatment beds. It’s easy to look at the statistics of this and feel acceptance – “wow, this is unfair, but this is just the way things are.” As much as I am growing to love clinical practice, I recognize that this issue is a community practice issue. Between our initial research course, and this community practice course, I feel like I’m actually gaining some of the skill needed to have any ability to address this issue in a meaningful way – something I absolutely lacked at the start of the program (passion aside).

            Involvement in this community practice project, and the nature of the research specifically, could not have come at a more appropriate time. In order to gather data, and meaningfully make the case that some of the detox practices are (or aren’t) effective, and in turn monitor client’s substance use over time (something that Milestone does not currently have the capacity to do), as researchers, we are going to be entering the community and engaging with clients outside of the human services sector, conducting relational work for a year. The tie to the literature we are reading in research is clear, however, there is definitely a connection to participatory practice and the participation theories we are thinking about in this course (Weil, 133). The substance abuse community (client and service providers) are heatedly advocating for increased services, and documentation of current practices that “work.” This information we hope to gather is supported by the community, which will hopefully increase client’s willingness to participate for the full term. Had I gone into this project with cold feet, feeling out of place and unjustified (similar to the way I felt in December), having no relationship with the clients to sustain, it may have been even more difficult to find clients who would agree to participate. Our discussion on authenticity, entering a community (as an outsider), and advocated for mutually supported change hit home with me, as I am beginning my first formal endeavor in social work community practice.

Reference:

Weil, M., Reisch, M., & Ohmer, M. (2013). The Handbook of Community

Practice. 2^nd Edition. Sage.