I ended a post a while back saying that Bob was going to write me up. That didn't happen, and I should have known better.
I type Bob's group notes.
I run groups I'm not supposed to run.
I update the milieu and group schedules.
I do all the client's orientation tests.
I help with scheduling the counselors for Bob.
I correct and format Bob's monthly manager spreadsheets.
I fix Bob's computer.
I never complain about doing the above-listed things that I am not at all supposed to do.
Unless I really put an effort into screwing up,
Bob will never write me up.
Wednesday, February 11, 2009
Clients or Cash - The Slippery Slope
The unit I work on has always maintained a pretty strict code of conduct because of the demographic of our clients: gang relations, criminal records, court-mandated. Most important among our rules are the ten Primary Rules. In the past, breaking a primary often resulted in a client being discharged. The Primary Rules are the ones you just can't break. They are supposed to be the hard line we hold so that the clients understand beyond a shadow of a doubt what is expected of them and what will not be tolerated.
No stealing
No gambling
No sex games
No acts or threats of violence
No tattooing or piercing
No interacting with the adolescent unit
No gang representation
No drugs or alcohol on unit
No disrespecting staff
No contraband
Our clients have an expected tendency to test limits and push boundaries. They don't do it because they're "criminals" or because they are "crooked" or "greasy," but because that's how they've learned to get what they want. The point of being in treatment is to learn how to be better, get better, and do better. But they're not necessarily supposed to like the process. That change is a hard change.
So its up to us to hold the line, to make them aware when they step over it and then teach them new ways to deal with their frustration. And when they take it too far, when they threaten or attack another client or bring drugs on the unit, when they endanger the safety of the other clients, we have to act in the best interest of the unit. We have to ask them to leave.
Things have changed
We the staff of the unit are no longer consistent in upholding the rules. Things are often allowed to slide. Once Bob was put in charge of the unit, things began to change. Because we are no longer doing what we're supposed to do, the clients have become restless and uncomfortable. The unit has become negative.
More clients have left our unit AMA (against medical advice) in the last two months than any similar period in the unit's history. I believe it may be as high as ten. And that was in the winter when we usually have none; its too cold to sleep outside.
Now the bean counters have never cared what happens on our unit. The company is owned by a for-profit corporation that specializes in running privatized prisons. The company has a contract with the state and they have a contract with the state to receive a certain amount of money for every bed that they fill per day. They have never followed up to see if clinical practices are being followed, so it has always been up to the unit to be self-policing in that respect. As long as there is no hub-bub for them to hear about in their office, and the milk and honey keep flowing, they're content.
Here's the slippery part
We became inconsistent and non-clinical in our practices. Clients are leaving AMA with great frequency. Suddenly we can't keep the beds full and the hive has started to lose money.
NOW they're interested in what's going on, but they don't have even the slightest idea of what should be done. There isn't a single person working above Bob that has any training or experience in addictions counseling. So instead of peering through a clinical lens and trying to adjust the unit, they've taken a different approach.
Since we've lost so many guys in the last two months, we're not allowed to kick anyone out. For anything.
Threatening to beat the hell out of someone? Nope. What if they rush the guy while yelling obscenities and pointing in his face? Nope. Cussing out staff in front of the rest of the clients repeatedly? Nope. What if they just don't do any treatment work? Nope.
How about "closing the house," where we shut down free time and focus only on treatment while we address serious grievances and behavior issues? Nope. For reasons I totally fail to understand, that's no longer allowed, either.
The clients have caught on. They don't know the specifics, but they've seen that hard line crack and they know that they can threaten each other, call each other horrible things, swear, yell, throw things, cuss at staff, break the rules, WHATEVER... and we won't kick them out.
Put it together and what do you get?
When you combine our inconsistency, the client's outlandish behavior, and the company's mandate to keep those beds filled, you get a free-for-all. The clients act out, and then various staff members decide they need to "clean up this town" and act out of anger or righteous retaliation towards the clients.
-------------------------
We have strong personalities on staff and we need a strong leader. Bob isn't able to rein in the hot issues and hold staff accountable, so we end up with a lot of singular cowboys trying to "tighten things up." And since we're not allowed to remove dangerous people.....
Hey, comments welcome. If I had an answer, I save the unit.
No stealing
No gambling
No sex games
No acts or threats of violence
No tattooing or piercing
No interacting with the adolescent unit
No gang representation
No drugs or alcohol on unit
No disrespecting staff
No contraband
Our clients have an expected tendency to test limits and push boundaries. They don't do it because they're "criminals" or because they are "crooked" or "greasy," but because that's how they've learned to get what they want. The point of being in treatment is to learn how to be better, get better, and do better. But they're not necessarily supposed to like the process. That change is a hard change.
So its up to us to hold the line, to make them aware when they step over it and then teach them new ways to deal with their frustration. And when they take it too far, when they threaten or attack another client or bring drugs on the unit, when they endanger the safety of the other clients, we have to act in the best interest of the unit. We have to ask them to leave.
Things have changed
We the staff of the unit are no longer consistent in upholding the rules. Things are often allowed to slide. Once Bob was put in charge of the unit, things began to change. Because we are no longer doing what we're supposed to do, the clients have become restless and uncomfortable. The unit has become negative.
More clients have left our unit AMA (against medical advice) in the last two months than any similar period in the unit's history. I believe it may be as high as ten. And that was in the winter when we usually have none; its too cold to sleep outside.
Now the bean counters have never cared what happens on our unit. The company is owned by a for-profit corporation that specializes in running privatized prisons. The company has a contract with the state and they have a contract with the state to receive a certain amount of money for every bed that they fill per day. They have never followed up to see if clinical practices are being followed, so it has always been up to the unit to be self-policing in that respect. As long as there is no hub-bub for them to hear about in their office, and the milk and honey keep flowing, they're content.
Here's the slippery part
We became inconsistent and non-clinical in our practices. Clients are leaving AMA with great frequency. Suddenly we can't keep the beds full and the hive has started to lose money.
NOW they're interested in what's going on, but they don't have even the slightest idea of what should be done. There isn't a single person working above Bob that has any training or experience in addictions counseling. So instead of peering through a clinical lens and trying to adjust the unit, they've taken a different approach.
Since we've lost so many guys in the last two months, we're not allowed to kick anyone out. For anything.
Threatening to beat the hell out of someone? Nope. What if they rush the guy while yelling obscenities and pointing in his face? Nope. Cussing out staff in front of the rest of the clients repeatedly? Nope. What if they just don't do any treatment work? Nope.
How about "closing the house," where we shut down free time and focus only on treatment while we address serious grievances and behavior issues? Nope. For reasons I totally fail to understand, that's no longer allowed, either.
The clients have caught on. They don't know the specifics, but they've seen that hard line crack and they know that they can threaten each other, call each other horrible things, swear, yell, throw things, cuss at staff, break the rules, WHATEVER... and we won't kick them out.
Put it together and what do you get?
When you combine our inconsistency, the client's outlandish behavior, and the company's mandate to keep those beds filled, you get a free-for-all. The clients act out, and then various staff members decide they need to "clean up this town" and act out of anger or righteous retaliation towards the clients.
-------------------------
We have strong personalities on staff and we need a strong leader. Bob isn't able to rein in the hot issues and hold staff accountable, so we end up with a lot of singular cowboys trying to "tighten things up." And since we're not allowed to remove dangerous people.....
Hey, comments welcome. If I had an answer, I save the unit.
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