New articles are published every Monday and sometimes in between.

Sunday, February 27, 2022

Regulatory expectations and requirements or "paperwork."


Dear Michael:

In response to your concerns about all the insurance regulations which must be followed to bill for services I jotted down some of my thoughts.

We can get caught up in the regulations, expectations, and requirements of running a business and practicing a profession when we manage a career in psychotherapy. This obsession with the trees precludes us from seeing the forest. The more basic questions that we overlook are:

What ultimately is the purpose of psychotherapy? 
Who are we ultimately working for?

One of the foundational concepts in TQM (Total quality management) is to know your customer. Who is your customer? There usually are many stakeholders in the business being managed. So these stakeholders can be put in priority.

The managed care model was built on a three legged stool. The model intended three things: good outcomes, achieved cost competitively, with customer satisfaction. Or as the bumper sticker says "Good, cheap, fast pick two."

At the end of the day I am on a mission from God and the client's needs and wishes are my ultimate concerns.

I went to a conference once presented by Michael White, the father of Narrative Therapy. He was asked a question by somebody in the audience who probably was a graduate student "Is Narrative Therapy research based?" Michael paused for a moment and then said, "Well, I am not a researcher. I am a practitioner. I don't know if Narrative Therapy is research based or not and it isn't my biggest concern. My concern is that it be ethically based."

Obviously, I have never forgotten this very important principle. We can worship at the altar of data or we can do the right thing. Hopefully these will usually be the same thing, but sometimes they are not and at the end of the world I'd rather be on the side of the ethical.

There is a line in A Course In Miracles, "Would you rather be right or be happy?" The need to be right may ultimately miss the point, right?

Saturday, February 26, 2022

What have you learned being a Social Worker for 53 years?

 Topic One

What have you learned being a Social Worker for 53 years?



David Markham at Park Ridge Mental Health Center in Brockport, NY on 12/07/1988



When I graduated from SUNY Albany in 1972 with a Master’s Degree In Social Work, students were expected in the second of their two years of study to concentrate in casework, group work, or community organization. This was the standard way of organizing graduate social work education until the 80s when Social Work education shifted to a generalist model emphasizing the major competencies as assessment, service planning, implementation, and evaluation at three levels of social organization, individual, group, and community, This led to practice at the micro, mezzo, and macro levels.


The career path I have followed has taken me through all these methodologies and levels. I have provided individual, family, and group counseling as a clinician and also systems management as a supervisor, program director, deputy director for programs, and finally as an executive director. I have also functioned as an adjunct college professor in Health Sciences and in Social Work.


Some people might say cynically that I have been a “jack of all trades and a master of none.” I certainly have been a generalist with wide ranging career experiences but I have mastered some of them and consider myself to have some knowledge, expertise, and skills that are valuable to the right people, in the right places, at the right time, delivered in the right way.


I am very grateful for the career I have engaged in and all the mentors and teachers who taught me along the way. This blog will, hopefully, capture some of this knowledge, experience, and practice wisdom that has been accumulated over 53 years of practice.


Social Work: A Lifetime Of Practice is back up and running.

 After 9 1/2 years Social Work: A Lifetime of Practice is up and running. It is the mission of this project is to capture a lifetime of knoweldge, skills, and practice for the use of subsequent generations of Social Workers and Human Service professional. Feedback and sharing is welcome.

Tuesday, July 3, 2012

The Medicated Child

Watch the Frontline documentary on the Medicated Child on Netflix which aired on January 8, 2008 by clicking here.

Monday, June 4, 2012

Harry and Tonto, the film

Harry and Tonto released in 1974 won Art Carney the Academy Award for best actor in 1975 is the story about Harry Combs, a retired treacher in his 70s, who is evicted from his life long home when his apartment building in New York City is demolished for a parking lot.

Harry is forced to adapt to a changing world and find a new place in it. He is a resilient man who is not ready to isolate himself from life withdrawing into the ambivalently caring arms of one of his three adult children.

This story has a lot to teach about how older parents can maintain healthy and functional relationships with their adult children. It also has a lot to teach about the importance of our relationships as human beings with animals, in this case a cat, Tonto, whom Harry dotes on and talks to as if the cat were a conscious witness to his life.

This movie is respectful of the third stage of life and is not condescending, patronizing, or sentimental. Harry maintains his dignity, self respect, and self determination throughout.

This film would be a good point of discussion for Social Work students studying gerontology and family therapy.

I am glad I finally watched it after it being out for over 38 years. It is as relevant today as it was when it was released in 1974.

I give it 4 out of 5 stars and recommend it.

American Teens Are Less Likely Than European Teens to Use Cigarettes and Alcohol, but More Likely to Use Illicit Drugs

American Teens Are Less Likely Than European Teens to Use Cigarettes and Alcohol, but More Likely to Use Illicit Drugs. To read the article on Science Daily click here.

Editor's note: The fact that American teens smoke less cigarettes and drink less alcohol than their European counterparts is a great thing even though they use more illicit drugs. Here's why: 30,000 Americans die every year from the so called "illicit drugs", 100,000 Americans die every year from alcohol, and 410,000 Americans die every year from tobacco. What's America's drug problem.

Further, there is no mention of the use/abuse of psychotropic drugs, and studies have shown that marijuana is more effective and has less side effects in managing psychiatric symptoms such as anxiety, ADD, depression than physician prescribed psychotropic drugs.

The fact that American teenagers are using less alcohol and tobacco than Europeans is an indication that our public health policies and prevention efforts are working in the United States. Many thanks to the substance abuse professionals and other people and organizations who have worked hard to produce these good results! 

I have spend over 20 years of my career working in the area of substance abuse prevention both professionally and personally. Two of my 9 children, Ryan aged 8, and Brigid aged 5, were killed in a drunk driving crash in 1993. They were killed by a 3 time drunk driver who had never received any treatment for his alcoholism and who was 35 when he killed my children was well know to have been a troubled teen who started drinking around age 13 or 14. The drunk driving fatalities have dropped from about 17,000 in the 80s and 90s to about 11,000 in 2010. It has taken a lot of work to bring about this positive change but 11,000 drunk driving deaths is still too high. If there were 11,000 Americans killed every year by terrorists, Americans would be engaged and willing to bomb only god knows who.

We, as a country, are on the right track, and we have accumulated a lot of practice wisdom over the last 4 decades on how to minimize the negative impacts of alcohol and tobacco use. May we continue the good work and get the death rates from alcohol and tobacco to zero.

Saturday, June 2, 2012

Two parent families in which the parents are married are better for kids

The number of single parents in America has increased dramatically: The proportion of children born outside marriage has risen from roughly 30 percent in 1992 to 41 percent in 2009. For women under age 30, more than half of babies are born out of wedlock. A lifestyle once associated with poverty has become mainstream. The only group of parents for whom marriage continues to be the norm is the college-educated. 
 
Some argue that these changes are benign. Many children who in the past would have had two married parents could have two cohabiting parents instead. Why should the lack of a legal or religious tie affect anyone’s well-being? 

There are three reasons to be concerned about this dramatic shift in family life.

First, marriage is a commitment that cohabitation is not. Taking a vow before friends and family to support another person “until death do us part” signals a mutual sense of shared responsibility that cannot be lightly dismissed. Cohabitation is more fragile — cohabiting parents split up before their fifth anniversary at about twice the rate of married parents.  Often, this is because the father moves on, leaving the mother not just with less support but with fewer marriage prospects. For her, marriage requires finding a partner willing to take responsibility for someone else’s kids.

Second, a wealth of research strongly suggests that marriage is good for children. Those who live with their biological parents do better in school and are less likely to get pregnant or arrested. They have lower rates of suicide, achieve higher levels of education and earn more as adults. Meanwhile, children who spend time in single-parent families are more likely to misbehave, get sick, drop out of high school and be unemployed.

It isn’t clear why children who live with their unmarried biological parents don’t do as well as kids who live with married ones. Adults who marry may be different from those who cohabit, divorce or become unwed mothers. Although studies try to adjust for these differences, researchers can’t measure all of them. People in stable marriages may have better relationship skills, for instance, or a greater philosophical or religious commitment to union that improves parenting. Still, raising children is a daunting responsibility. Two committed parents typically have more time and resources to do it well.  

Third, marriage brings economic benefits. It usually means two breadwinners, or one breadwinner and a full-time, stay-at-home parent with no significant child-care expenses. Unlike Murphy Brown — who always had the able Eldin by her side — most women do not have the flexibility afforded a presumably highly paid broadcast journalist. And it’s not just a cliche that two can live more cheaply than one; a single set of bills for rent, utilities and other household expenses makes a difference. Though not necessarily better off than a cohabiting couple, a married family is much better off than its single-parent counterpart.

Sawhill, Isabel Twenty Years Later, It Turns Out Dan Quayle Was Right About Murphy Brown and Unmarried Mom, http://www.brookings.edu/research/opinions/2012/05/25-unmarried-mothers-sawhill

Editor's note: The loss of the basic building block of modern society, the two parent family, contributes to increasing social problems for society. I see this in my practice on a daily basis. No family is perfect, and all families are dysfunctional in one way or another, but the question of whether some family configurations are better at raising children than others has been proven repeatedly, and the findings are clear that two parent families where the parents are married get better results in raising children.

Do these findings mean that all parents should stay married no matter what for the sake of the children? Of course not. Life is more complicated than that. Do these findings mean that no individual can do a good job raising a child, or children, alone, of course not. But in general, when it's possible, two married parents with loving extended family make the best milieu for the raising of children. Does our society support this model in such a way that it is the normative model that people are encouraged to emulate? Societal support has been weakening with the diminishing influence of our religious institutions, the lack of support from our social institutions such as schools, the social welfare system, and the criminal justice system. We pay lip service to the important role that parents play but then our major social institutions insert themselves as "experts" in family life and undercut the role of the parents.

Our social welfare policies would rather see women working in minimum pay jobs and place their children in day care than support them in parenting them themselves. This is a very misguided policy and is backfiring when we see the social symptoms of school failure, drug abuse, and criminal activity in the young.

In some communities such as the African American community black men are incarcerated at higher rates than are in college and because of these policies their children and their children's mothers are deprived of the presence and support that these men could provide.

Unlike other first world countries, the United States does not provide much support for parenting in the form of child subsidies, health insurance, and other economic support. With our capitalistic model we value money more than we do our children, and the social indicators measuring the well being of children and their families are much poorer in the United States than other first world countries.

I will be providing more data on this phenomenon and commentary in future articles. It is important for social workers, regardless of their field of practice, to be aware of the factors in our society than impact child and family welfare so that we can advocate for social policies that will enhance our mutual quality of life. Marriage is good thing for our society: heterosexual and same sex marriage, and we would benefit and our clients would benefit, if we advocated for cultural norms and factors that support it.