Tuesday, October 31, 2006

Priorities

Four year old children at local psychiatric hospitals and wards are in bed right now. The nurses have patted backs, given meds, soothed tears and in some cases talked with worried parents about their child's progress. Social workers have completed family sessions, received hugs from tiny arms and logged the day's last progress notes. Doctors on call will still jump slightly when the phone or pager goes off--you just never know who might be in crisis tonight.

These four year olds are not hospitalized only because of some evil hospital corporation that lures families onto psych wards.

They're admitted by parents who are at their wit's end. They're admitted because they are unable to control themselves, or because they are so depressed that they want to die, or because their violence has become dangerous to the whole family.

They're admitted because there are no psychiatrists in the area who will take on another Medicaid patient and most family physicians won't prescribe medication for mental illnesses in children.

They're admitted after social workers or other licensed mental health professionals do an exhaustive interview with the child, family, other clinicians or DFS, and sometimes law enforcement. They're admitted after a nurse talks with the family and then contacts the on-call doc who usually makes the final determination and issues the admit orders.

One reason it seems like more four year olds are in these hospitals in recent months is because they are being denied, or having to wait for Missouri Medicaid to authorize psychology and counseling services. When they do authorize therapeutic intervention, Missouri Medicaid will only authorize family therapy services for young children. That's it, and it is not enough.

When confronted with concerns that four year olds are being admitted to psych wards, representatives from Medicaid didn't express concern that families feel so desperate for help that they are turned to this as a last resort because their health coverage won't pay for an outpatient clinician to provide treatment. These people didn't seem worried about how the changes they've supported might contribute to the desperation.

They were concerned about fraud.

They asked what hospitals were admitting the kids. They talked about investigating.

They did not discuss the possibility that if families and children could readily access outpatient mental health services from the provider they feel most comfortable with, fewer children would need to be hospitalized.

A typical 50 minute hour of individual or family counseling costs Medicaid $48. One day in a psychiatric hospital, according to SAMHSA reports, may start at over $407.

So, Missouri can "buy" about ten sessions of counseling or one day in a hospital.

Certainly there is fraud in some of these hospitals, and it is important and appropriate for these agencies to be investigated. But it just floored me to hear these people immediately focus on "investigating fraud" instead of imagining the horror a young child or their family must feel to be in the position that psychiatric hospitalization feels like the only option.

They won't authorize $48 for a young child to have an individual counseling session. They'll decide who gets what therapy by looking at faxed paperwork. They'll insist that only one kind of therapy is appropriate, ignoring bodies of well-respected research.

The children are just lost in the dialog.

Friday, October 27, 2006

Such cruelty

Norma Champion, Springfield's state senator, said twice this week that the people who were cut from the Medicaid roles aren't going without health care. "They're getting health care somewhere" she asserts.

WTF?

I just can't believe she actually thinks this is true, much less that she said it in public. It is beyond naive, it is purely ignorant. Uninformed. Inaccurate. Wrong. Incredibly sad.

Champion and her legislative colleagues are clearly out of touch with the reality that people living in poverty and the working poor face every day. And she's also not processing the fact that when the uninsured poor do get health care, it is usually in an emergency room. They're not getting preventive care. They're not getting their medicine, they're waiting until there is no other option before they present at the ER for help.

The day after I heard Norma Champion insist that uninsured Missourians aren't going without health care, I met "Liz." I talked with her at the factory where she works because she couldn't leave for a conference about her child.

Liz's teeth are black with decay. She can't afford a dentist. Her oldest child, in preschool now, is developmentally delayed, evidences bizarre behavior-possibly on the autism spectrum, and probably major hearing loss because of scarring related to repeated ear infections. Liz desperately wants every service available to her child. She knew something was wrong, but didn't know to ask the doctor about her worries, partly because she rarely sees the same doc twice, and partly because she simply didn't know she should mention it.

I had to talk to her about this through the cigarette smoke and gossip of her co-workers who eat their lunches out of old butter cartons on scarred wooden tables adjacent to the work floor. Liz's lunch was leftover noodles--barely enough to fill a cup.

Liz earns $240 a week at the factory, which she uses to support herself and her two children--their dad is in prison and offers no help. Liz is losing her Medicaid in January. The Missouri government says she makes too much money. Liz takes an anti-seizure medicine for a mental illness. She knows enough about her illness and her symptoms to say that if she can't take her meds, she'll lose her job because of the symptoms. But she won't be able to afford it. Without Medicaid, the medicine will cost $250--more than she earns in a week.

Norma Champion thinks Liz will still get health care when Norma and her fellow legislators take away her Medicaid.

Even though she works hard every day, Liz will be lucky if she can afford to feed herself those leftover noodles, let alone get health care.

Norma Champion and her fellow Republican legislators must have lost their souls somewhere between here and Jefferson City.

What other possible excuse could they have for such cruelty?

Friday, October 20, 2006

The News Leader...

actually endorsed a leader today. When they endorsed Doug Harpool for the 3oth Senate district, the editorial board at the Springfield News Leader made an intelligent decision. Norma Champion has served her community in many ways, but her effectiveness is negligible, and we need someone who will speak for the folks s/he represents, not just toe the party line. When Champion told a group of physicians that they had "good lobbyists" whom she admits she listens to, she completely lost me.

I like Harpool's independence, and I am old enough to remember what he accomplished as a state rep. I am also old enough to remember the whole "aunt norma" and the puppet hour gig, but hosting a kid's cartoon show does not make someone an effective political leader.

I write this entry from a hotel room "far, far away" as the little ones say, where I have attended conference session after conference session on the state of early childhood education, and education for young children with disabilities. If anything, these sessions remind me of how incredibly far-reaching every political decision is.

People who ignore politics, or pretend it doesn't affect them are sadly mistaken. The politicians at every level make decisions that affect every single one of us, from cradle to grave, every single day.

In Harpool, Springfieldians have the opportunity to support a politician who has a record of being independent, and who is focused on how issues affect his constituents (regardless of whether they've got a lobbyist to speak for them).

The News-Leader got this one right.

Tuesday, October 17, 2006

A social worker was killed for protecting a baby today.

There are so many horrors associated with child abuse and neglect--obviously the abused child is the primary focus early in a case. After a short period of time, the focus includes reuniting the child with his/her parents, and helping the parents learn how to take care of the child. Sometimes, no matter how hard you work, the parent simply can't or won't do what is needed to regain custody, or even just keep the child safe during a visit. Often the social worker trying to protect the child, ends up "stuck" between the alleged abusers, law enforcement and the abused or neglected child.

Today a social worker was killed trying to do her job--she was taking a baby to it's mom for a supervised visit. The social worker was 67 years old. She cared for and about children. Now she is dead.

"Social Worker Beaten to Death, Baby Missing"
www.cnn.com


"A search is under way for a mother and her boyfriend who are believed to be on the lam with her nine-month-old baby after a social worker was beaten to death.

Boni Frederick's body was found in the Henderson, Kentucky, home of the mother, Renee Terrell, after a scheduled supervised visit.

An Amber Alert was issued for Saige Terrell. The little boy was placed in foster care because of neglect, said police Sgt. Dwight Duncan.

Saige is believed to be with his mother and her boyfriend, Christopher Luttrell, 23, police said Tuesday.

The victim's vehicle may have been spotted Monday night at a gas station near Smithboro, Illinois, in rural Bond County, police said.

Police have issued a warrant for Renee Terrell, 33, on kidnapping charges.

Employees from the state's Cabinet for Health and Family Services found the body of social worker Boni Frederick, 67, of Morganfield, Kentucky, Monday in the mother's home, where Frederick had taken the child for the supervised visit. The child had been placed in foster care because of neglect, said police Sgt. Dwight Duncan.

According to an autopsy done Tuesday, Frederick was beaten to death. She suffered multiple blunt and sharp-force injuries, said police in Henderson.

Duncan said Frederick was supposed to be at the mother's home from 9 to 11 a.m. to supervise the visit. A family services spokeswoman said co-workers went to the residence after they had not heard from her.

Frederick worked with the department for 15 years and was a "passionate, dedicated" employee, said spokeswoman Vikki Franklin. As a social service worker, she said, Frederick's primary duty was transporting children to and from family visits and doctor appointments.

She also said that it is common for a social worker to travel alone, but if a worker is concerned about safety, he or she can request an escort by a police officer or another social worker."


Most social workers, most do-gooders, expect the best from people. Even after way too many years of seeing the worst, of being frightened to go into trailers guarded by pit bulls, of seeing the horrors that adults inflict upon children, we keep going in. We keep trying. And we keep expecting to be safe.

Today that expectation got someone killed.

I hope the baby is safe. That's probably all Boni Fredricks wanted, too.

Thursday, October 12, 2006

Blunt's Medicaid cuts strike again

"Margaret" looks like a figure out of a Grant Wood painting. Her thin hair frames a face lined by years of worry, her toothless smile doesn't make it to her eyes. When she came to see me, I wrongly assumed she was the tiny four year old's grandmother.

One week after her last child was born three months premature, this mother had a heart attack. The doctors couldn't believe that at her age she'd just had a baby--she had to show them her c-section incision--but when they realized what was happening, they gave her immediate treatment, including angioplasty and medications. More than three years later, about the same time that her cardiologist told her she needed more serious heart surgery, she lost her Medicaid. See, her husband makes 9.50 an hour, and with her little disability check, our state government decided they make too much money for her to keep her Medicaid coverage.

They can't afford the fees to put her on her husband's insurance. They can't afford the surgery, they can't even afford to keep her on her heart medications regularly. Margaret's biggest fear is that she won't live long enough to raise her little boy.

This from the government officials who tout their moral superiority and "Christian" values.

Those government officials should take notice though; Margaret will be voting in November, and this time she won't be voting for them.

Friday, October 06, 2006

More groovy blogs

http://wwwhelensparkles.blogspot.com/ This blogger lives in the UK, has cool photos and some interesting insights into regular life across the pond.

http://thegirlwho.squarespace.com/ Pithy and straight-at-you commentary of life in New York. Linked through Sparkles site, it is a fun read.

http://thaimy.blogspot.com/ Young lady in Vietnam posts photos and english descriptions of her world.

It is just so cool to be able to get glimpses into life in other parts of our world. Hallelujah for the random blog buttons.

Lost is back!

Oh happy day. "Lost" is back on the air, and thus the monkey on my back leaps for joy. Feeding the addiction, doncha know.

Watched the premiere on Wednesday with the Young One, and then took great pleasure in going to abc.com yesterday to watch it again. I wanted to see if they showed the title of the Stephen King book the Others were discussing, as well as scope out some of the finer details. So many questions left unanswered.

Hot diggity dog! (as we Okies like to say)

Those questions cause the anticipation for next Wednesday. When they stop with the new episodes, though, after a few weeks, I will be rather a pain on Wednesday evenings. The jones is bad kiddies.

Anyone in blogland watch the new ensemble show after Lost, the Nine? I did, and although I absolutely do not want or need another silly TV show to get hooked on, it was a bit intriguing. Hmmm.

Thursday, October 05, 2006

Clueless

Norma Champion, and no doubt many other state lawmakers, are simply clueless when it comes to the realities of Missouri Medicaid. As reported on the KY3 blog, Champion, in a forum for physicians, stated: "We now are going to check eligibility, that wasn't being done," Champion noted. "Also, we're checking if the family has access to other healthcare, they can use that first."

Has she ever met someone on Medicaid? Has she ever even just checked into how the program has been run? If she had, she would have already known that OF COURSE the social service workers at DFS regularly check eligibility for the children and families receiving Medicaid. I can't even count how many times I have tried to bill on a client and found that their Medicaid is no longer active because they forgot (or didn't know they needed) to reapply for eligibility.

And, every time I bill on a child who has access to any other health insurance I must first show proof that I tried to get payment from the other insurer first.

But here's the biggest question for these lawmakers who think they have some sort of insider knowledge into Medicaid recipients and providers: Why in the world would anyone WANT Missouri Medicaid over other types of insurance? It is a last resort. Most dentists won't accept it. Most medical clinics and hospitals have caps on how many Medicaid patients it will serve. Many doctors won't even bother, and often the ones who do are overworked, and way underpaid. And if you've read any of my blog posts about how Medicaid funds mental health services you know how incredibly messed up that is.

Instead of accusing our citizens of ripping off the government by actually wanting healthcare for their children, or accusing the do-gooder physicians, dentists, and mental health professionals who will provide medical care for Medicaid recipients of defrauding the system, our representative and senators would be doing a much more important service if they would look at how to improve the medical care families in poverty can receive.

They should figure out how to use the funds to make certain every single child in this state has the same access to excellent health care.

Is there some reason the children don't deserve this?

Here is the final insult to the citizens:

"I work with your lobbyist and he's very good about telling me your concerns," Champion told the medical group.

She gets her information from the lobbyists.

Please, God, give us a government of people who get their information from the people they represent.

Wednesday, October 04, 2006

The children lose again.

Previous thinkingthings posts have explained a little about how changes to Missouri's Medicaid system have made it impossible for young children to receive individual counseling. A state committee has decided that kids under age 5 don't need that sort of counseling. And now they are punishing the clinicians who try to work with young children.

Local clinicians, after trying repeatedly to get approval to work with young children, even with family therapy (supposedly still available) are being turned down for reasons related to paperwork errors--not clinical judgement. Children are waiting, literally for months, to receive services, and in many cases, they never get the therapy. Clerical workers site reasons like the clinician didn't put AM or PM on the plan, or list an office room number.

State statistics show that 11% of young children are denied mental health services. Anecdotal evidence show that significantly higher percentages of kids are waiting for weeks on end to be approved. Those kiddos don't show up in the stats because they aren't "rejected," so the State can spout this 11% number with what they believe is impunity. But when you are four, traumatized or in crisis, a week feels much, much longer, a month-like a year.

The committee reports say that Medicaid will pay for crisis intervention without prior authorization. However, four year olds aren't really entitled to this apparently, because at least one state employee told a local clinician that young children don't really have suicidal or homicidal crises.

One clinician, who has moved to a different state recently to be able to actually perform counseling for children in poverty, was audited by Missouri Medicaid. The auditors said this clinician had an "excessive" number of crisis intervention sessions. During the time period audited, the clinician had billed five (5) crisis sessions. An example: a four year old child hitting, kicking and spitting on a teacher and threatening to kill the teacher with a knife. How about the four year old child who brought his older brother's switchblade knife to preschool and told another child exactly how he planned to use it to hurt a teacher. Or this one: a child with an autism spectrum disorder cannot tolerate change or a new environment. He takes a pair of scissors and stabs another 4 year old in the face, barely missing
an eye.

Sounds like crisis behavior to me.

But, the same state that licenses counselors and social workers also seems to think that the people who man the fax machines have better clinical instincts about the children.

And if Medicaid doesn't want to intervene with children when they're young, they are basically asking for more trouble, and more expense, when the children become teenagers. I mean really--if a four year old copes with stress and trauma by stabbing someone and still is not able to access help, what do we expect from this same child at fourteen?

Last weekend I saw our Governor and his wife on TV doing a Public Service Announcement about the importance of early childhood services.

He talks a good line at election time, doesn't he?

In the past four months some of the best counselors, social workers and psychologists I've known, and who have been willing to accept Medicaid and work with families living in poverty, have just given up. Three clinicians have moved out of state. Two clinicians have accepted paid employment, three others have continued their practices but can't afford to work with young children anymore. At least two are so frightened of state retribution that they won't even look up Medicaid information on their home computers. And three clinicians report being singled out for Medicaid audit after making complaints about the system changes to their legislators.

It sure seems to me that what the Missouri State government wants is to not have to pay for mental health services through Medicaid. So if they can't just stop the Medicaid program completely, it seems they will make it virtually impossible for the providers to be paid for their work. If they run off the good providers, it won't really matter if the program exists or not.

With mental health providers giving up the fight, it isn't just that the government decision- makers win, it is that the children lose.

Jackson Browne said it:
http://www.lyricsfreak.com/j/jackson+browne/for+america_20068571.html

By the dawns early light
By all I know is right
We're going to reap what we have sown