An Evening with Karen Casey

As I mentioned in my previous blog, our agency has faced some budget cuts and we have had to diversify our strategies for funding. We have become more creative with our fundraising and had a successful theater event earlier this year. We have planned another event that will actually be held at the England Building by ASU’s downtown campus.

Since our program is based on recovery concepts, we have secured a woman named Karen Casey who is an expert on meditation and reflection. This is an important step in 12 step programs and Ms. Casey has written a book entitled “Each Day a New Beginning,” which is a daily meditation book to help folks in recovery learn the process of meditation. I am including the info on the event on this blog and a link to order tickets.

Tickets are now available for NCADD Presents Karen Casey

Saturday, March 17, 2012
Karen Casey is the bestselling author of over 20 inspirational titles, including Each Day a New Beginning. She will be in Arizona on March 17 to share her guidance. 
Tickets can be purchased through Sustain.

Healthcare Cuts

A significant piece of legislation touted by Governor Jan Brewer as an answer to Arizona’s budget problems has culminated in a high court ruling this week. Before I share about this ruling (I will provide a link to the news coverage from the AZ Republic), I want to give you some background. 

I believe that one of the things that makes the United States and other developed nations great is that they are welfare states. Consider this definition of a welfare state from the Britannica Encyclopedia:

“(A) concept of government in which the state plays a key role in the protection and promotion of the economic and social well-being of its citizens. It is based on the principles of equality of opportunity, equitable distribution of wealth, and public responsibility for those unable to avail themselves of the minimal provisions for a good life. The general term may cover a variety of forms of economic and social organization.” 

Certainly with significant economic challenges being faced in Arizona it is seems easy and simple to cut entitlements. Indeed, those who have need of said entitlements are the most disenfranchised politically and have the least access to lawmakers, in part this is largely due to the daily struggle for survival. When one is concerned about the basics that many of us take for granted, issues in the political spectrum seem incredibly distant and inaccessible, and yet these political decisions shape their lives in incredibly important ways. For lawmakers, this population is an easy target because of misinformation and stigmatization that plagues the poor. People often believe that individuals are poor by choice, that they are simply lazy and take advantage of the system to get everything for “free.” This intolerance and stigmatization only increases in times of economic struggle, as resources lessen and the innate human instinct for survival rears its head, people begin to look out for themselves and remain ignorant of the struggle of the silent poor. 

Therefore, it comes as little surprise that Governor Brewer decided to cut AHCCCS (Title XIX) funding for all single Arizonans. This funding cut to healthcare started back in July/2011 and has gone through a series of court rulings since then. Brewer believes that this initiative will save the state a significant amount of money, but my question is at what cost? 

A significant amount of funding that our non-profit receives is through Title XIX funding that is allocated through the Regional Behavioral Health Authority (RBHA), which in Maricopa County is Magellan of Arizona. For this fiscal year, all programs that are funded by Magellan took relatively large funding cuts. For our program, it was a 10% contract cut off of the top, and a sort of back door cut by cutting our rate repayment amount. This concept is a bit complicated and certainly outside of the scope of this blog, but nonetheless behavioral health took some huge hits. This did not come as a surprise to our program and we certainly understood the conundrum that both the RBHA and the State of Arizona was/is facing. There are no easy solutions to complex systemic problems. While we are fortunate enough to have a brilliant CFO who was able to preserve all of our jobs (with a pay freeze, not even a cost of living raise), most programs had to lay off people. I mention this because these cuts are to help the state save money, but laying people off during a repressed economy results in those folks being out of work for some time and likely collecting unemployment. This is also a significant cost to the state. And while NCADD has had to operate more efficiently and become more creative with finding funding sources and opportunities, our agency has been deeply concerned with the medical consequences of the healthcare cuts.

Beginning in July, we began to receive single women into treatment who did not have healthcare and were well below the federal poverty guidelines. These women had chronic medical conditions like diabetes, high blood pressure, etc. and the circumstances have not changed. Many of our women are in need of psychiatric assistance and cannot receive needed mental health medications because of their lack of healthcare coverage. We began to see the human cost of the political decision and it has been challenging to overcome. It is important to consider what the ultimate cost is to the state by not approving those in poverty conditions to have healthcare interventions. Consider this: if a diabetic is without insulin for too long, that individual is going to have more significant complications that could, and likely will, lead to hospitalization to stabilize. In addition this population has been forced to misuse the emergency room for routine or non-emergency health concerns due to not having the resources to access medical professionals. These individuals do not have the funds to repay the hospital and the hospitals cannot deny emergency treatment. Thus, while costs may be somewhat cut in the short term, the long term consequences of this decision are highly costly economically, socially, and morally. Consider that the income for a single person living below the federal poverty guideline is $10,890 a year. That equates to $209.42 per week. Could any of us survive on that little? Could you meet your health needs? Do we live in a world where someone who is this poor ought not be helped? 

So, what was the ruling of the high court? Well, the high court decided that the answer to my last question is yes and yet, it also decided that the legislature is acting unconstitutionally by acting against a voter approved ballot measure, but that the cuts stand. A strange decision indeed. Take a look at some of the political details in the following article. 

http://www.azcentral.com/arizonarepublic/news/articles/2012/02/15/20120215medicaid-issue-before-arizona-supreme-court.html

I am interested in hearing all of your thoughts. 

New Programs at NCADD

I previously outlined our longstanding and stable programs that we have at NCADD. In the past fews years we have grown exponentially and have added specialty programs that serve women and children. I will outline them below:

Healthy Connections for Moms to Be

Healthy Connection is a program for expecting mothers who struggle with addiction. This is a harm reduction case management program that works to connect pregnant and addicted mothers to prenatal care, substance abuse treatment, safe housing, and any other necessary resources. Case managers meet with clients regularly and connect them to resources in the community. May Healthy Connections clients enter into a long term residential treatment program called Center for Hope. This program is approximately one year and provides safe respite and intensive treatment to prepare addicted women for motherhood and long term sobriety. Our case managers also provide home visits to meet clients where they are at and they are often at the hospital when the babies are born. We have a wall of photos of all the healthy babies that have been born since the inception of our program. 

Legacy House

The Legacy House program is out newest program and is a home that provides emergency and interim housing for pregnant women with substance abuse issues and also in some cases will serve single women with an interim housing need. The Legacy House is a safe home that can accommodate approximately five women. It is fully staffed with two case managers and also peer support. Clients are required to engage in treatment and also attend outside community based support meetings, as well as enjoy weekend “sober fun” activities to learn how to enjoy life without drugs and alcohol. 

Sustain

Our final new program is the Sustain vocational training program. One of the biggest sociological barriers to those with addiction issues is finding and maintaining employment. Typically our clients have an unstable and inconsistent work history, may or may not have felonies or may be unable to pass a background check, and have limited education and usually are without high school equivalency. Sustain offers an answer to some of these barriers by acting as a work training program. It is a recycled retail store with an online shopping component to train clients on a wide array of employable activities. Clients also receive a stipend of goods for their work. Some of the activities include customer service training, cash handling training, computer enhancement skills, and retail skills (sorting clothes, stocking, etc.). This program is managed by a vocational counselor who also institutes a GED preparation group twice a week. Many of our clients have successfully achieved high school equivalency and have found stable and successful long term employment. 

I think it is important to note that our program is holistic. Each of these programs interact with each other and clients may be involved in many facets of each in order to rise above the depths to which they have fallen. What we offer is comprehensive, evidence-based, and effective. In these last few posts I have tried to illustrate the components of our program. My relationship to each of these programs is both as a supervisor and an implementor. I clinically supervise each of these programs and also facilitate a young adult group. I will describe my interactions in future posts. I am going to add a link for Sustain and also for program description. 

http://www.sustainchildrenstoysandclothes.com/

http://www.ncadd-phx.org/programs.html

The Color Run Experience!

Last week I took part in the craziest 5k run in town! It’s called the Color Run and it was the first time it was held in Arizona. We had a team that participated that included my mom and sister. It was such a beautiful day and because my sister is attending graduate school in Monterey it was such a wonderful memory maker!

Here is how it worked. It was a white shirt dress code at the starting line because every k that you ran resulted in a color fun explosion thrown onto your person. By the time you completed the event, you were covered in various colors from head to toe. It was such a fun experience and a great way to stay in shape. It was held at Tempe Beach Park and all different types of people and families attended, and even some dogs participated in the run. I am not exactly sure that they were convinced with the ginormous color clouds that had to be run through, but in general they seemed to have a good time. Check out my pic below at the end of the run.

I have been very focused on balanced living for the past year, which has included healthy nutrition and regular exercise. I attend a semi-private training class at Sommet Fitness (http://www.sommet-fitness.com/) with two friends at 5am two days a week. I find if I don’t work out first thing, it gets more challenging to fit it in by the end of the day. I also try to get some cardio in three times a week, but since this semester started I have found it difficult to fit it all in. The weather has been so amazing and it has offered such a great opportunity to enjoy Arizona’s halcyon outdoors. It is idyllic and I love to take advantage of it. I have a yellow lab (Chloe - 6 months now) and we are currently caring for a friend’s chocolate lab (Zeus) and both love to go hiking with me. I know that keeping focused on fitness gives me the energy to do all that I do. I have become so much stronger this past year and I love all that I am able to do physically.

 I have been feeling a little sluggish these past two weeks after getting over an illness, so I think I am going to try a vegan cleanse suggested by Alicia Silverstone on her website, www.thekindlife.com. If anyone has ever done a cleanse, I would be interested in hearing how it went for you. I think I am going to try the 6 day cleanse and see how it goes. It would be nice to rid myself of all those crazy toxins. The cleanse I am thinking of doing is called kaeng raeng (http://www.kaengraeng.com/).

Anyway, Happy Super Bowl Sunday! Here’s to great commercials and even better football.

NCADD-Our Programs

Well, this semester is definitely going to be an endurance trial for me. I am currently taking two Master’s courses (American Global Power: Religion, Gender, and Human Rights and The Qur’an and Women) , both of which are pretty intensive and require A LOT of reading! However, I am learning so much and I am so excited to be a part of such intelligent and respectful discourse. Nonetheless, this workload and course of study has caused me to neglect this blog this past week. Add to that, I have been terribly sick, but I am finally feeling soooo much better. It is so important to practice self care when engaging in all these activities.

Anyway, for this entry I really want to focus on breaking down the programs that exist under the NCADD umbrella. But first, I also want to clarify my role, so that you may keep this in mind as I describe the programs. As I think I mentioned in my first post, I am the Clinical Director for NCADD and my role is to manage each of these programs, which includes staff, quality management, documentation, program implementation, etc.

To begin, when I began working for NCADD six years ago, it was a small non-profit that served a relatively small clientele and employed about 14 people full time. In six years time, we now employ 35 people full time and we have also increased our part time population. This is in large part due to the exponential growth that we have had with our programs. Six years ago we had two programs operating: an outpatient substance abuse treatment program and Weldon House (a transitional living environment for women and children).

OUTPATIENT: The basic elements of the outpatient counseling program include weekly groups and individual counseling for those clients that seek out our services. These groups and services are facilitated by licensed and/or master’s level therapists and social workers who implement an established curriculum with their own interpretation and approach. This program is broken down into three levels: Level 1: an introduction/education/group orientation level, Level 2: a process group to address core issues that typically cause substance abuse, Level 3: an aftercare and support level. Most of our population is referred from Child Protective Services (CPS) and Terros Families First for substance related concerns that impact children in terms of neglect and abuse. This is an often stigmatized population and our work is focused on care and compassion to those that are sick and suffering.

WELDON HOUSE: This program is the brainchild of our current CEO Thelma Ross and is truly unique. It consists of 17 apartments/town homes that are fully furnished. Clients that are accepted to the program have traditionally completed some form of residential treatment or have engaged in out patient counseling services for a period of time and have displayed some desire for change. Clients that enter into the program are on an orientation period for 30 - 60  days. During this time, communication with family and friends is limited, so that the client will focus on acclimating to the community and begin adjusting to the rigorous treatment schedule. Due to the community nature of Weldon House and the vulnerable populations that live there, family members must go through a screening process in order to visit the community. The primary intent of Weldon House is for each client to have their own home to learn, in a supportive environment, how to be a sober mom. After clients complete orientation they transition into Level I, which consists of attending primary treatment groups four days a week, weekly individual counseling, parenting group, life skills group, dual diagnosis group, DBT, and possibly other ancillary services depending on the client needs. Treatment is completely individualized and is person-centered. One of the primary goals of Weldon House is to assist clients in achieving self sufficiency as an answer to some of the shorter term resolutions that are often explored with indigent clients. Many programs are limited by time constraints and often answer the resource challenge through referrals to minimum wage jobs that leave clients in poverty conditions and increases recidivism into welfare programs. Weldon clients work with a vocational counselor to begin educational and vocational development, so when they discharge from the program they have a marketable skills set that can sustain a single parent family without being reliant on state welfare. Graduates of our program have entered into a variety of careers including veterinary technicians, accounting, social work and counseling, nursing and medical careers. Many clients come to us without high school diplomas or equivalency, however, most graduates of Weldon leave with a minimum of a GED. When clients move into Level II, their treatment schedules decrease and their vocational programming intensifies. When clients complete training and begin work they successfully transition from the program. This is individualized for each client.

I might add here that clients at Weldon attend their treatment at the NCADD outpatient program, but there is a therapist that is the provider for the program along with case managers and peers supports. Also, outpatient clients have access to the same ancillary groups as Weldon House. Also, it may be important to note that NCADD-Phoenix is gender specific. Anyway, these were the programs in place when I began working with NCADD. Since then, we have added three more programs and we continue to expand. I will discuss those programs in greater detail in my next blog!