TCM and MRO

Yes, there is not sufficient services, yet our Medicaid dollars keep getting cut. If the Feds have their way, I may be seeking a new job by summer 2010. One that doesn't involve extreme shifts to Targeted Case Management for individuals with mental illness and significantly limiting MRO.

By these changes, I mean some of the ones I am already seeing other Community Mental Health Centers (CMHCs) make in their ways of working. Many of the school providers are now implementing a TCM system in which one worker does all the assessment and linkage (to resources/services), one worker does the MRO interventions such as ADLs (activities of daily living), and a third worker does all the clinic (someone like me, who would only do individual, group and family therapy). This means there are three workers for one client. That sounds like a waste of money rather than being fiscally efficient, if you ask me.

On top of the monetary irregularities in this plan, it goes against social work philosophy. Many of the kids I work with are so transient, moving from home to home, they are lucky to stay with one clinician for the duration of treatment (which for me can mean years- these kids and families have chronic needs). Or, in the case of my current school, all my kids will lose me as their therapist after the summer because the school is closing. Now, with these proposed regulations (TCM expected to go in effect possibly after they move beyond the Moratorium and MRO changes that are slated for July 2010) kids will not only be subject to the constant changes in their day to day lives, but will have at least three workers serving their needs. Of course, I am speaking about my kids, in the communities I work in. For some populations and traditional outpatient offices this may work. But for me, this would mean I am not allowed to have a conversation with the teacher about how they are doing, assist them in the classroom or advocate for their needs at an IEP case conference- because I can't bill for it.

I can only take so much more of my job being all about billing. I know it keeps us going, but these are human lives we are talking about. It's about quality of care and appropriate therapeutic services to the individualized need.