"Be the change you wish to see in the world."

Tuesday, May 4, 2010

Band aids for Bullet holes: EBPs

LA county has had a long history of putting bandaids over bulletholes. Most recently there has been a budget crisis that has lead to quick fixes like major teacher lay offs. Anyone with common sense would say that LAUSD is already providing such an unacceptable level of education to our children that it seems like a strange choice to reduce the amount of teachers. California has laid off government employees, increased sales tax to almost 10%, cut programs like Healthy Families and CalWORKs, and even released hundreds prisoners early. Again... common sense says these are not solutions. And don't even get me started on how lack of education leads to an increase in the prison population because thats a subject for a whole other post.

The latest solution that affects social work is the budget cuts within the Department of Mental Health (DMH), from which most of the community mental health agencies get their funds. Some other counties are simply cutting entire programs, mostly adult programs. Although I understand why childrens' programs are the most protected, if we "fix" the adults, then the children wouldn't need as much support. LA county has made a smart decision by trying to avoid cutting entire programs because they recognize the chaos that would occur if they stopped providing services for a large population in this crazy city.

However, instead they are forcing Evidence Based Practices (EBPs) on the mental health workers. In order to received funds from DMH, they are requiring the use of therapeutic practices that have been researched and proven to be successful. EBPs, in my opinion, are a double edged sword. On the one hand, I am being trained in effective techniques, such as Trauma- Focused Cognitive Behavioral Therapy and Seeking Safety. These practices have been proven to decrease symptoms in clients who have experienced trauma and there are many great tools that these EBPs provide for clinicians.

On the other hand, clinicians are now chained to the models and unable to use their own discretion about what might be best for their clients. Furthermore, most EBPs are short-term (about 3 months in length). Many of the clients who seek services through community mental health agencies require more intensive and longer term treatment. In particular, Seeking Safety, is more like teaching a course than therapy. There are 25 topics with hand outs and materials that the therapist goes over with the client. Niether of these EBPs emphasize the therapeutic relationship, which I have always felt is the most useful part of treatment. Another troubling obstacle this presents is MORE paperwork. Anyone who has ever done DMH paperwork knows how time consuming and aggravating it is. I spend more time doing paperwork than seeing clients most weeks. This amount of paperwork already seems ineffective. Again... using some common sense one could deduce that if we had less paperwork, we could provide an increased quality and quantity of services.

Do you use EBPs? How are budget cuts effecting your work?

1 comment:

  1. Booo! This is all for funding sake and is ridiculous. Im sure this plan, like the bandaid plan, will fail and we will all be back to square one. When will the honchos realize they need preventative care?