Help Pro Publica Investigate Temporary Staffing Agencies

Anyone who has ever worked for some of these temporary staffing agencies almost invariably has a horror story about the pay, the hours, the conditions they were forced to work under, the treatment they received at the employment site, and/or the treatment they received at the hands of the temp agency employees themselves.

Many of us have horror stories that include all of the above, and all occurring on the same day.

The most memorable one for me was when I was working as a temp for a company that supplied the big 3 automakers with chrome pieces for the vehicles.  They will remain nameless as I don't want to end up floating in the toxic waste they crank out by the swimming pool load every day (I've clearly been watching too much of the series "Damages" )

I was a second shift forklift operator on the shipping dock of this company, located "somewhere" in mid-western Michigan.  The company often had 5 gallon cans of cyanide and these "mini-kegs" of sulfuric acid stacked on pallets and then stacked top of each other.  No, I am not kidding. Not sure what they used it all for, but I believe it was used in the chroming room.

This chroming room had some nasty chemical soups that would have to be disposed of, and they dumped it into a sealed bin that had to be kept closed, as prolonged contact with air would cause it to burst into flames.  Niiiicccee.

They also had these big flat open air containers that they would fill to about a foot from the top with chemical sludge waste and about once a month, a truck with a boom lift would come in, pick this massive dumpster up with a crane and load it on the back of a truck.  This was accomplished by hooking the crane's lift hook into a set of chains in the center of the dumpster and then just gently lifting and swiveling the mess onto the back of the truck.

Trouble was, the container, even tho it was filled with liquid, wasn't particularly equal in the weight distribution, since some of the waste that was dumped had thick sludge.  Because the forklift trucks could only dump on one side and towards one end of the container, it often was heavier on one side and end than the other.

So one day I was on duty when the boom-truck arrived to put this bubbling, smoking witches brew monstrosity onto the truck.

As the crane lifted the container, it tilted, spilling about half of the contents onto the floor.  The foreman, obviously scared, ordered all of the "temporary" employees to the shipping dock over the loudspeaker.  He then gave the 8 or 9 of us stupid enough to show up push brooms and rubber knee boots and instructed us to "sweep it into the floor drain." 

One of the guys went down into the soup and began sweeping the muck and within minutes was bright red, gasping for air and came running out of the mess.  His boots were smoking and the bristles on the broom were....gone.

The Foreman began yelling at us to "get down there and clean it up," and I told him to "f*ck off," threw the broom down and promptly left the premises.  Not sure about the rest of those poor saps, but after seeing those smoking boots and the bristles of that broom turned into slush, there was no way on God's green earth I was going to get anywhere near that shit.

I reported the company to the EPA the following day.  Not sure they ever did anything; I drove by that plant often and the hundreds and hundreds of 55-gallon drums of waste chemicals were still stacked outside the dock.  The area 1000 feet in any direction around those barrels looked like something out of a post nuclear war landscape, and I often wondered how many people were permanently damaged by the work they did in that factory.

I lost my job at the temporary service for "failing to perform the job assignment."

It's probably why I'm still alive to write this today.

If you've got a story, please share it with the folks at Pro Publica.  You could save someone's life, and at the very least, you may make temporary work a little better for those coming after you...

Have You Worked With a Temp Agency? Help Us Investigate

ProPublica, Apr. 29, 2013, 9:00 am

iStock photo by ricardoazoury

Today we published an investigation on temp agencies in Chicago and the underground labor brokers (known as “raiteros”) who recruit and transport their workers. Reporter Michael Grabell spoke with temp workers who were making less than minimum wage after having to wait for hours off the clock and pay fees for rides to work or getting their paycheck.
Have you worked with a temp agency as a worker, recruiter, or client company? We’re trying to gain a broad perspective. Do you have any tips about issues or situations we should investigate? We want to hear from you.
Tell us your story below (your information will be kept confidential) or contact reporter Michael Grabell directly at Michael.Grabell@propublica.org.
* * *

¿Ha trabajado con una agencia temp? Ayúdenos a investigar.

Hoy hemos publicado una investigación sobre las agencias de trabajo temporal en Chicago y el submundo de intermediarios de empleo (conocidos como “raiteros”) que reclutan y transportan a sus trabajadores. El reportero Michael Grabell habló con trabajadores temporales que ganaban menos del sueldo mínimo después de tener que esperar horas sin cobrar y también pagar tarifas por el transporte al trabajo o para recibir su cheque de paga.
¿Ha trabajado usted con una agencia temp (de trabajo temporal) como trabajador, reclutador o empresa cliente? Estamos intentando conseguir una perspectiva amplia. ¿Tiene usted alguna pista sobre asuntos o situaciones que tendríamos que investigar? Queremos que se ponga en contacto.
Cuéntenos su historia en el espacio debajo (su información será mantenida en la confidencialidad) o contacte directamente con el reportero Michael Grabell a Michael.Grabell@propublica.org.

Prison Profits: "success depends on housing the maximum numbers of inmates for the longest potential time as inexpensively as possible."

Aside from the sickening motivation that arises when shareholders pressure for-profit prisons to produce ever higher dividends, the potential for subversion of the rule of law and the ease in which politicians - who can also invest in these for profit pens - can criminalize behavior to keep them full is beyond terrifying.

We have a mega-problem in this country that arises with the mentality that the default solution to every societal woe that ails us is to send lawbreakers to jail.  Couple this with the power of the criminal justice Lobbying arm and the ability for lawmakers to invest in for profit prisons and you have a real recipe for disaster.

The power of this cabal becomes clearly apparent when solid research on the efficacy of alternative solutions to produce better outcomes than incarceration are repeatedly defeated in favor of "building more prisons," mandatory sentences, 3-strike laws, etc. The clearest supporting evidence I can provide of my fear around how easy it is to "customize justice" is this:

"African-Americans make up 40% of the prison population and are incarcerated seven times more often than whites, despite the fact that African-Americans make up only 12% of the population."

Moral monstrosity: America’s for-profit Gulag system

Nile Bowie is a political analyst and photographer currently residing in Kuala Lumpur, Malaysia.

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Published time: April 23, 2013 14:42

Maricopa County female inmates are padlocked by the ankle for chain gang duty in Phoenix, Arizona October 21, 2003. (Reuters/Shannon Stapleton)

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Crime, Human rights, USA

The private prison population in the US has rocketed 17-fold over the last two decades mostly on the shoulders of the deep-pocketed prison lobby, and the business continues to thrive.

Try confining yourself to a small room in your home, like a bathroom or a closet, and spend a few hours there. One only cringes to imagine the detrimental psychological effects that kind of solitude creates for individuals who are subjected to solitary confinement for years at a time, knowing only the walls of their cell and the shades of light that creep across them. The abhorrent state of affairs at the Guantanamo facility often makes international headlines and arguably overshadows the calamity that is the US domestic prison system – where over six million people are subject to some form of correctional supervision, an amount exceeding those who toiled in the Soviet gulags during Stalin’s reign.

In the United States, some fifty thousand inmates pass their days in solitary confinement. While there is undoubtedly no shortage of violent criminals in America’s jails, millions are dolled out annually by privately owned prison lobbies directly to politicians in an effort to influence harsher ‘zero tolerance’ legislation and mandatory sentencing for many non-violent offenses.

While the US faces economic stagnation and unprecedented spending cuts to programs of social uplift, business is booming for the private prison industry. Like any other business, these institutions are run for the purpose of turning a profit. State and federal prisons are contracted out to private companies who are paid a fixed amount to house each inmate per day. Their profit depends on spending the minimum amount necessary on each inmate day-to-day, allowing private-hands to pocket the remaining money.

For the corrections conglomerates of America, success depends on housing the maximum numbers of inmates for the longest potential time as inexpensively as possible. Consider that the United States has the highest incarceration rate in the world, far surpassing any other nation – for every 100,000 Americans, 743 citizens sit behind bars. The harsher sentences meted out to non-violent offenders in contrast to other industrialized nations speaks volumes of America’s enthusiastic embrace of a prison industrial complex.

Inmates walk around a gymnasium where they are housed due to overcrowding at the California Institution for Men state prison in Chino, California, June 3, 2011. (Reuters/Lucy Nicholson)

The number of people imprisoned under state and federal custody increased 772% percent between 1970 and 2009, largely due to the incredible influence that private corrections corporations wield against the American legal system. The argument is that by subjecting correctional services to market pressures, efficiencies will be increased and prison facilities can be run at a lower cost due to market competition.

What these privatizations produce in turn is a system that destroys families by incentivizing the mass long-term detention of non-violent criminals, a system that is increasingly difficult to deconstruct and reform due to millions paid out to state and federal policymakers. According to reports issued by advocacy group Public Campaign, the three major corrections firms –Corrections Corporation of America (CCA), the GEO Group, and Cornell, have spent over $22 million lobbying Congress since 2001.

As a means of influencing policymaking at the federal level, at least $3.3 million have been given to political parties, candidates, and their political action committees, while more than $7.3 million has been given to state candidates and political parties since 2001, including $1.9 million in 2010, the highest amount in the past decade. Senators like Lindsay Graham and John McCain have received significant sums from the private prison corporations while Chuck Schumer, Chair of the Rules Committee on Immigration and Border Enforcement, received at least $64,000 from lobbyists.

The prison lobby thrives off of laws that criminalize migrants and submit them to mandatory detention prior to being deported, sometimes up to 10 months or more; private firms have consistently pushed for the classification of immigration violations as felonies to justify throwing more and more immigrants behind bars. The number of illegal immigrants being incarcerated inside the United States has risen exponentially under Immigration and Customs Enforcement, an agency responsible for annually overseeing the imprisonment of 400,000 foreign nationals at the cost of over $1.9 billion on custody-related operations.

The private prison industry has become increasingly dependent on immigration-detention contracts, and the huge contributions of the prison lobby towards drafting Arizona’s controversial immigration law SB 1070 are all but unexpected. Arizona's SB 1070 requires police to determine the immigration status of someone arrested or detained when there is “reasonable suspicion” that they’ve illegally entered the US, which many view as an invitation for rampant racial profiling against non-whites.

While the administration of Arizona’s Governor Jan Brewer is lined with former private prison lobbyists, its Department of Corrections budget has been raised by $10 million in 2012, while all other Arizona state agencies were subject to budget cuts during that fiscal year. The concept of privatizing prisons to reduce expenses comes at great cost to the inmates detained, who are subjected to living in increasingly squalid conditions in jail cells across America. In 2007, the Texas Youth Commission (TYC), a state agency that overseas juvenile corrections facilities, was sent to a West Texas juvenile prison run by GEO Group for the purpose of monitoring its quality standards.

Administrative segregation prisoners take part in a group therapy session at San Quentin state prison in San Quentin, California, June 8, 2012. (Reuters/Lucy Nicholson)

The monitors sent by the TYC were subsequently fired for failing to report the sordid conditions they witnessed in the facility while they awarded the GEO Group with an overall compliance score of nearly 100% - it was later discovered that the TYC monitors were employed by the GEO Group. Independent auditors later visited the facility and discovered that inmates were forced to urinate or defecate in small containers due to a lack of toilets in some of the cells. The independent commission also noted in their list of reported findings that the facility racially segregated prisoners and denied inmates access to lawyers and medical treatment.

The ACLU and Southern Poverty Law Center have also highlighted several cases where GEO Group facility administrators turned a blind eye to brutal cases of rape and torture within their facilities, in addition to cases of its staff engaging in violence against inmates. According to the Justice Department data, nearly 210,000 prisoners are abused annually (prison personnel are found responsible half the time), while 4.5 percent of all inmates reported sexual assaults and rape.

It’s not possible to conceive how such institutionalized repression can be rolled back when the Obama administration shows only complicity with the status quo – a staggering $18 billion was spent by his administration on immigration enforcement, including detention, more than all other federal law enforcement agencies combined. Under Obama’s watch, today’s private prison population is over 17 times larger than the figure two decades earlier. Accordingly, Obama’s drug czar, Gil Kerlikowske, has condemned the recently passed state laws in Colorado and Washington that legalize the possession of marijuana in small amounts.

The Obama administration is bent on keeping in place the current federal legislation, where a first-time offender caught with marijuana can be thrown in prison for a year. It’s easy to see why common-sense decriminalization is stifled - an annual report released by the CCA in 2010 reiterates the importance of keeping in place harsh sentencing standards, “The demand for our facilities and services could be adversely affected by the relaxation of enforcement efforts, leniency in conviction or parole standards and sentencing practices or through the decriminalization of certain activities that are currently proscribed by our criminal laws. For instance, any changes with respect to drugs and controlled substances or illegal immigration could affect the number of persons arrested, convicted, and sentenced, thereby potentially reducing demand for correctional facilities to house them.”

An inmate stands in his cell at Men's Central Jail in Los Angeles, California October 3, 2012. (Reuters/Jason Redmond)

Such is the nature of a perverted brand of capitalism, and today’s model bares little difference to the first private prisons introduced following the abolishment of slavery in the late 1800s, where expansive prison farms replaced slave plantations where predominately African-American inmates were made to pick cotton and construct railroads in states such as Alabama, Georgia and Mississippi.

Today, African-Americans make up 40% of the prison population and are incarcerated seven times more often than whites, despite the fact that African-Americans make up only 12% of the population. Inmates are barred from voting in elections after their release and are denied educational and job opportunities. The disproportionate levels of black people in prisons is undeniably linked to law enforcement’s targeting of intercity black communities through anti-drug stipulations that command maximum sentencing for possession of minute amounts of rock cocaine, a substance that floods poor black neighborhoods.

Perhaps these social ills are byproducts of a system that places predatory profits before human dignity. Compounding the illogic is that state spending on prisons has risen at six times the rate of spending on higher education over the past two decades. Mumia Abu-Jamal, America’s most famous political prisoner, has spent over three decades on death row; he was convicted in 1981 for the murder of a white police officer, while forensic experts say critical evidence vindicating Jamal was withheld from the trial.

In an interview with RT, Jamal relates his youth activism with the Black Panthers party against political imprisonment in contrast to the present day situation, “We could not perceive back then of what it would become… you can literally talk about millions of people incarcerated by the prisoner-industrial complex today: men, women and children. And that level of mass incarceration, really mass repression, has to have an immense impact in effect on the other communities, not just among families, but in a social and communal consciousness way, and in inculcation of fear among generations.”

The fear and immortality the system perpetuates shows no sign of abating. Being one of the few growth industries the United States has left, one can only imagine how many people will be living in cages in the decades to come.

"0.4 Percent" A Reason To Celebrate? Sort Of...

Haven't read through the new National Alliance To End Homelessness's "State of Homelessness" report in its entirety and wanted to state that at the outset, but from what I've seen so far, I think they did a thorough and excellent job in their report.

If there is any encouraging news coming from the info that leapt immediately out to me, it was that there was an oh-so-slight decrease in homelessness over the past couple of years, 0.4 percent. 

Ordinarily, I would say this is not only bad news, it should be embarrassing and shameful news for those of us who work in this field because clearly we are doing everything wrong.  Frankly, if this was the case under "normal" circumstances, I'd say we ought to simply fire everyone who works in homeless services and use all the money we pay in salaries, overhead and administrative costs to purchase as much affordable housing as we can while increasing the supply of Section 8 vouchers. Once that's done, we should then get the hell out of the way of those who would stampede their way into housing (and there are many, I know, who would argue we ought to just do that anyway!)

But the past few years have been anything but "normal" for many of us, especially those of us living at or below the poverty line here in the U.S.A.

Unemployment has remained consistently high (and contrary to the ignorant view that "homeless people don't want to work" we know that most folks enduring homelessness do indeed work, often at several jobs, trying like hell to get far enough ahead to be able to afford the thousands of dollars typically needed to enter into an apartment).

Affordable housing units are in extremely short supply.  Housing subsidies (Section 8, VASH, Shelter Plus Care) are next to impossible to even apply for and the waiting lists for a voucher can exceed 5 years in places.

Rules, regs and background checks flag people out of services far more than we are able to flag them into services, leaving them without any recourse and chaining them damned near permanently to a life on the streets. 

Budget cuts and diminishing grant access has reduced the size of the workforce to support and assist folks in navigating their way out of homelessness.

So when I see any decrease at all in homelessness in our current situation, I think that is reason to remain optimistic that we must be advancing in our approach and our solutions geared toward ending homelessness.

A lot still needs to be done, certainly, and the 0.4 percent number is nothing to be proud of.  But I think given what many of us were expecting to happen over the past few years, we have reason to be happy we saw any decrease at all. 

The State of Homelessness in America 2013

Report | April 8, 2013

Files: The State of Homelessness 2013 (PDF | 9.42 MB | 56 pages) SOH 2013: Chapter 1 - Homelessness Counts (PDF | 2.96 MB | 11 pages) SOH 2013: Chapter 2 - Economic and Housing Factors (PDF | 4.41 MB | 10 pages) SOH 2013: Chapter 3 - Demographic and Household Factors (PDF | 2.12 MB | 4 pages) SOH 2013: Executive Summary (PDF | 130 KB | 3 pages) SOH 2013: Appendices (PDF | 315 KB | 20 pages)

This is an excerpt from the report. To download the full report, please use the link above.
Executive Summary
The State of Homelessness in America 2013 examines trends in homelessness between 2011 and 2012 as well as the economic, housing, and demographic context in which homelessness changes over time. The report shows that, overall, the homeless population decreased by less than 1 percent, but this is not the full story. While the number of people experiencing homelessness as part of a family increased slightly, the number of individuals experiencing chronic homelessness and those identifying as veterans decreased significantly.
The mixed findings may be related to policy changes as well as to the economic climate in which these changes are taking place. Increased federal investment in effective solutions, such as permanent supportive housing, has been aimed at veterans and chronically homeless individuals. Also, during this time period, flexible federal resources were available to communities through the Homelessness Prevention and Rapid Re-housing Program (HPRP) to help prevent and end homelessness for families and individuals. Despite these resources, increased competition for housing resources and growing housing cost burden combined with increases in the size of the population living in doubled-up situations and poor single-adult-headed families make attaining and maintaining housing more difficult for families and single adults who are not chronically homeless.
Report Contents
The National Alliance to End Homelessness has published a series of reports chronicling changes in the levels of homelessness in the nation and individual states and jurisdictions in an effort to chart the nation’s progress in ending homelessness. The most recent of these, The State of Homelessness in America series, not only examines changes in national- and state-level homelessness data, but also provides data on related economic and demographic trends.

The State of Homelessness in America 2013, the third in a series from the National Alliance to End Homelessness, uses the most recently available national data from a variety of sources: U.S. Department of Housing and Urban Development, U.S. Census Bureau, U.S. Bureau of Labor Statistics, National Association of State Budget Officers. This report includes three chapters. Chapter One presents data on homelessness at the national and state levels using point-in-time estimates of the overall homeless population and subpopulations, measured in 2011 and 2012. Chapter Two describes economic and housing factors that impact homelessness including housing cost and unemployment. Chapter Three describes demographic and household factors that impact homelessness including population groups that are at increased risk.

A series of appendices provide detailed, state-level information on all homelessness data and contextual factors described in this report as well as two-year trends.

Major Findings
Homelessness
Using the most recently available national data on homelessness, the 2011 and 2012 point-in-time counts as reported by jurisdictions to the U.S. Department of Housing and Urban Development, the report chronicles changes in overall homelessness and in homeless subpopulations between 2011 and 2012. Point-in-time methodologies vary and are imperfect and, as such, the aggregated numbers do not represent a precise count of homeless people. The counts, however, when compared over time, provide a way to assess whether the homeless population has increased or decreased.

• The nation’s homeless population decreased by 0.4%, or about 2,325 people. At a point in time in January 2012, 633,782 people were experiencing homelessness. There was a decrease in all homeless subpopulations with the exception of persons in families.
• The largest decreases were among individuals identified as chronically homeless (6.8%) and Veterans (7.2%). The size of the chronic homeless population decreased from 107,148 in 2011 to 99,894 in 2012. The size of the Veteran homeless population decreased from 67,495 in 2011 to 62,619 in 2012.
• The national rate of homelessness was 20 homeless people per 10,000 people in the general population. The rate for Veterans was 29 homeless Veterans per 10,000 Veterans in the general population.
• A majority of persons identified as homeless were staying in emergency shelters or transitional housing, but 38% were unsheltered, living on the streets, or in cars, abandoned buildings, or other places not intended for human habitation. The size of the unsheltered population remained basically unchanged between 2011 and 2012.
• The number of people in homeless families increased by 1.4% between 2011 and 2012; however, there was no change in the number of homeless families.
• While the overall homeless population decreased between 2011 and 2012, it increased in 29 states.

Economic and Housing Factors
Homelessness is essentially caused by the inability of households to pay for housing. In recognition of this, this report examines a variety of economic and housing indicators that affect people who are homeless or at risk of homelessness. Each of these factors is examined for the years 2010 and 2011, the most recent for which they are available.

• Nationally, median household income decreased by 1.3% between 2010 and 2011, from $51,144 to $50,502. While the majority of states reported a decrease in median household income, 14 states reported increases.
• Between 2010 and 2011, the national poverty rate increased from 15.3% to 15.9%. This represents an almost 5% increase in the number of persons living in poverty; more than 48 million people were living in poverty in 2011.
• The unemployment rate decreased from 9.6% to 8.9% between 2010 and 2011, which represents a decrease of more than one million people who were unemployed in 2011.
• While spending on Medicaid increased between 2010 and 2011, spending on Public Assistance decreased.
• Among the 51 states, 38 reported an increase in the fair market rent between 2010 and 2011. Nationally, the average fair market rent for a two-bedroom housing unit increased by 1.5%.
• In 2011, more than 6.5 million households were spending more than 50% of their income for housing expenses, which was a 5.5% increase from 2010.
• Approximately one-third of households were renting their homes in 2011, a slight increase from 2010. Correspondingly, the rental vacancy rates decreased from 10.6% to 9.7% during this time period.

Demographic and Household Factors
A number of demographic groups have an increased risk of homelessness, including poor households who are living in doubled-up situations, single-person households, and family households with only one adult present.

• Between 2010 and 2011, all but 11 states reported an increase in the number of poor people living in doubled-up households. Nationally, there was a 9.4% increase.
• At the national level, there was an almost 6% increase in the number of poor single-person households. In 2011, 12.9% of all households living in poverty were comprised of a single person.
• More than one-half of the households living in poverty were family households with a single adult present. The number of these households increased by almost 6% between 2010 and 2011.
• In 2011, 48.6% of adults living in poverty were accessing safety net benefits, which represents an 11.5% increase from 2010.

Moving Forward
The State of Homelessness 2013 identifies a number of challenges and opportunities in the efforts to prevent and end homelessness in the United States. Scant decreases in the overall size of the homeless population and the rate of homelessness between 2011 and 2012 remind us that there is still a great deal of work to be done. However, the decreases in chronic and veteran homelessness indicate that, with federal, state, and local investment in strategies proven to end homelessness, progress can be made. The ongoing and increased development of permanent supportive housing, a proven solution to ending homelessness for people with disabilities, is bringing down chronic and veteran homelessness numbers in communities across the country.
Emphasis needs to be placed on creating more affordable housing and strengthening the safety net to prevent homelessness. Federal assistance that was previously available to fill some of those gaps—through the Homelessness Prevention and Rapid Re-housing Program (HPRP)—has been depleted and not replaced. Still, rapid re-housing works: communities have been able to decrease the amount of time households spend homeless and increase the number of households they serve.
Federal investment in rapid re-housing is increasing, but it is still not sufficient to address all of the need. During Fiscal Year 2013, the U.S. Department of Veterans Affairs made $300 million available for community-based grants for homelessness prevention and rapid re-housing through the Supportive Services for Veterans Families(SSVF) program. The Administration also published a memo to states urging them to consider using Temporary Assistance to Needy Families (TANF) assistance to help families gain and maintain housing stability. The new Emergency Solutions Grant (ESG) program does provide flexible resources for communities to rapidly re-house households, but it has not been fully funded.
Finally, efforts to improve data quality and ongoing assessment of need and planning for interventions need to continue. Efforts include developing consistent and better methodologies for conducting the annual point-in-time counts of homeless persons. In addition, the HUD requirement that youth be included in the point-in-time counts will provide much needed information on an overlooked homeless subpopulation and provide a more comprehensive view of homelessness in the United States.

Pragmatic: practical as opposed to idealistic

One of keys to ending homelessness is being proactive enough to avoid it in the first place. Our current state of affairs in America don't align well with the idea of being "proactive" to just about anything.

In fact, we increasingly are becoming reactive to dire situations, forcing us to apply very expensive bandaids to exsanguinating social wounds that are literally bleeding our coffers dry in the process.

Many of the problems faced by those in poverty are a direct result of systemic responses to a variety of political decisions.  The root of most of our problems can be found from our social and political structures that create insurmountable challenges and barriers for many, while benefiting the few.

If you want to end homelessness, you must be able to make sure that the citizens of a given community have at their disposal the tools and resources necessary to support them while they labor to take care of themselves.

When a man or woman works 40 hours a week at a minimum wage job and cannot afford the price of rent for a 1 bedroom unit in any city in the United States, that is a systemic problem. 

When a man or woman falls ill or becomes injured and cannot afford the price of their own healthcare, forcing them into bankruptcy and poverty as a result, that is a systemic problem.

When a man or woman falls victim to the ravages of alcoholism or addiction and is sent to jail rather than into treatment, that is a systemic problem.

Solutions to these, and so many other, problems are not only available, they've been studied and their efficacy is documented. Unfortunately, pragmatic, sensible solutions don't seem to rise to the top very often when lawmakers endeavor to address the resultant challenges of broken components within our system. 

I'd prefer not to place the blame solely at the feet of Republicans, as the article below appears to do, because the truth is that politicians under the Democrat tent have for a very long time been just as culpable, just as "blameworthy" for the current system we operate under today. 

It would be nice if we could have our politicians throw out the Party labels and operate under the same pragmatic principles so many of us are forced to use when we wonder how we're going to pay the rent this month and put food on the table.

Sadly, those are issues politicians don't typically have to worry about, since often the rules they create for us don't apply to them....

Explaining Socialism To A Republican

2012/12/11

By Nurse Pam

I was talking recently with a new friend who I’m just getting to know. She tends to be somewhat conservative, while I lean more toward the progressive side.
When our conversation drifted to politics, somehow the dreaded word “socialism” came up. My friend seemed totally shocked when I said “All socialism isn’t bad”.  She became very serious and replied “So you want to take money away from the rich and give to the poor?”  I smiled and said “No, not at all.  Why do you think socialism means taking money from the rich and giving to the poor?
“Well it is, isn’t it?” was her reply.

I explained to her that I rather liked something called Democratic Socialism, just as Senator Bernie Sanders, talk show host Thom Hartman, and many other people do. Democratic Socialism consists of a democratic form of government with a mix of socialism and capitalism. I proceeded to explain to her the actual meaning terms “democracy” and “socialism”.
Democracy is a form of government in which all citizens take part. It is government of the people, by the people, and for the people.
Socialism is where we all put our resources together and work for the common good of us all and not just for our own benefit. In this sense, we are sharing the wealth within society.
Of course when people hear that term, “Share the wealth” they start screaming, “OMG you want to rob from the rich and give it all to the poor!”  But that is NOT what Democratic Socialism means.
To a Democratic Socialist, sharing the wealth means pooling tax money together to design social programs that benefit ALL citizens of that country, city, state, etc.
The fire and police departments are both excellent examples of Democratic Socialism in America.  Rather than leaving each individual responsible for protecting their own home from fire, everyone pools their money together, through taxes, to maintain a fire and police department. It’s operated under a non-profit status, and yes, your tax dollars pay for putting out other people’s fires. It would almost seem absurd to think of some corporation profiting from putting out fires.  But it’s more efficient and far less expensive to have government run fire departments funded by tax dollars.
Similarly, public education is another social program in the USA. It benefits all of us to have a taxpayer supported, publicly run education system. Unfortunately, in America, the public education system ends with high school.  Most of Europe now provides low cost or free college education for their citizens. This is because their citizens understand that an educated society is a safer, more productive and more prosperous society. Living in such a society, everyone benefits from public education.
When an American graduates from college, they usually hold burdensome debt in the form of student loans that may take 10 to even 30 years to pay off. Instead of being able to start a business or invest in their career, the college graduate has to send off monthly payments for years on end.
On the other hand, a new college graduate from a European country begins without the burdensome debt that an American is forced to take on. The young man or woman is freer to start up businesses, take an economic risk on a new venture, or invest more money in the economy, instead of spending their money paying off student loans to for-profit financial institutions.  Of course this does not benefit wealthy corporations, but it does greatly benefit everyone in that society.
EXAMPLE  American style capitalistic program for college: If you pay (average) $20,000 annually for four years of college, that will total $80,000 + interest for student loans. The interest you would owe could easily total or exceed the $80,000 you originally borrowed, which means your degree could cost in excess of $100,000.
EXAMPLE  European style social program for college: Your college classes are paid for through government taxes.  When you graduate from that college and begin your career, you also start paying an extra tax for fellow citizens to attend college.
Question - You might be thinking how is that fair? If you’re no longer attending college, why would you want to help everyone else pay for their college degree?
Answer - Every working citizen pays a tax that is equivalent to say, $20 monthly.  If you work for 40 years and then retire, you will have paid $9,600 into the Social college program.  So you could say that your degree ends up costing only $9,600. When everyone pools their money together and the program is non-profit, the price goes down tremendously. This allows you to keep more of your hard earned cash!
Health care is another example: If your employer does not provide health insurance, you must purchase a policy independently.  The cost will be thousands of dollars annually, in addition to deductible and co-pays.
In Holland, an individual will pay around $35 monthly, period.  Everyone pays into the system and this helps reduce the price for everyone, so they get to keep more of their hard earned cash.
In the United States we are told and frequently reminded that anything run by the government is bad and that everything should be operated by for-profit companies. Of course, with for-profit entities the cost to the consumer is much higher because they have corporate executives who expect compensation packages of tens of millions of dollars and shareholders who expect to be paid dividends, and so on.
This (and more) pushes up the price of everything, with much more money going to the already rich and powerful, which in turn, leaves the middle class with less spending money and creates greater class separation.
This economic framework makes it much more difficult for average Joes to ”lift themselves up by their bootstraps” and raise themselves to a higher economic standing.
So next time you hear the word “socialism” and “spreading the wealth” in the same breath, understand that this is a serious misconception.
Social programs require tax money and your taxes may be higher. But as you can see everyone benefits because other costs go down and, in the long run, you get to keep more of your hard earned cash!
Democratic Socialism does NOT mean taking from the rich and giving to the poor.  It works to benefit everyone so the rich can no longer take advantage of the poor and middle class.

When Hopelessness Dictates Your Day, There's Nothing Left To Say

Every time I see a story or a discussion describing how politicians, social workers, or direct service providers in the behavioral health field will be taking what is commonly referred to as an "Urban Plunge" I cringe, because while the event can certainly provide a taste of the street life, it misses - almost completely - the most critical component of the experience of living life homeless. For those who don't know, the Urban Plunge requires an individual(s) spend an evening or two "on the streets" to emulate the experience of homelessness (some have even tried the "experience" for a month or more, to "really get the feel" for the plight of homelessness).

Although life lived homeless has serious impact on the health and safety of an individual, the more insidious component of living homeless is the desperation and resignation that accompanies the hopelessness of the situation.  The Urban Plunge can never simulate this because in the back of the minds of those who engage in it, there is the knowledge that when it ends, life goes back to normal for them.  So long as one knows there is light at the end of the tunnel, one can endure practically anything because they realize the current situation is only temporary.

Hopelessness is extraordinarily debilitating and brings with it a host of psychological challenges that exacerbate the situation in myriad ways.

Hopelessness fuels homelessness.

The other key component in my mind is the shift that can occur in a person's thinking about what is "acceptable" to do when one is desperate versus when one is enjoying the safety, security and stability of a life lived housed and predictable. Put a person's back against the wall and strip him/her of all legitimate opportunity to improve their situation and you have created the potential to unleash pragmatic responses that may not always necessarily be in line with what our "civilized," inculcated, cultural and societal norms might be.

So when I read the story below and coupled it with the generalized lamentations of those I know personally who are struggling to get a job or who have given up entirely in even trying to find work, I worry.

A lot.

In fact, I think this kind of hopelessness around ever being able to support yourself and/or your family again puts a person into a very vulnerable psychological position and has serious potential to create a climate of pragmatism that won't always jibe with what society might consider a "normal" response or approach in addressing the problem. 

From "survival" theft of food items to suicide and all points in-between, we cannot expect everyone who experiences the hopelessness related to unemployment without the prospect of a new job to respond appropriately. The resultant psychological and physical trauma that accompanies the reduction in the quality of life that often follows job loss (loss of insurance means loss of treatment for medical issues, self esteem issues and ramifications; depression; anxiety; etc) affects different people differently.

Some are able to stoically cope, while others turn to vices to deaden the pain, anxiety and boredom. Still others struggle and collapse from the weight of the situation upon their shoulders.  But the loss of hope I think makes people more susceptible to those pragmatic survival decisions and it becomes easier to rationalize and justify as one struggles simply to exist. 

The Jobs Crisis: It May Not Be "Breaking News," But It's Definitely "Broken News"
Posted: 04/16/2013 9:15 pm
Arianna Huffington

BREAKING! This just in: the economy is terrible and the country is suffering its worst jobs crisis since the Depression... developing...
Of course, this isn't actually breaking news -- it's aching news -- and, before the tragic bombings in Boston, the most important story going on. But you wouldn't know that if you watched any of the Sunday shows last week.
On CBS' Face the Nation, the topics were the background check bill and immigration, with Senator Marco Rubio.
On ABC's This Week we had the president's budget, Jay-Z's trip to Cuba, Ken Burns' Jackie Robinson documentary and immigration, with Senator Marco Rubio.
On NBC's Meet the Press, they went with the background check bill, the president's budget, Ken Burns' Jackie Robinson documentary, and immigration, with Senator Marco Rubio.
CNN's State of the Union went with a wild card -- North Korea -- and then the president's budget and immigration, with... (how'd you guess?) Senator Marco Rubio.
Virtually unmentioned was the economy and the long-term jobs disaster that's been enveloping the country for five years now. The only mentions jobs got were in the context of the debate over whether immigrants might take away the jobs of hard-working Americans. The plight of many millions of Americans who are actually out of work is apparently not very newsworthy. Or at least not as newsworthy as an American rapper traveling in Cuba. Or a Cuban-American traveling in Washington to all four Sunday news shows.
Yes, I know I've banged this drum before, but it is hard to believe that what the Center on Budget and Policy Priorities calls the "longest, and by most measures worst economic recession since the Great Depression" doesn't warrant a mention on shows ostensibly devoted to the biggest news stories. Talk about missing the forest for the trees. Only in this case, the forest has largely been clear-cut.
But just because something is old news doesn't mean it's not still important news. Perhaps we need to come up with an alternate term to the breathless "BREAKING" tag. How about "BROKEN"? Yes, the story has already been broken, but the real story is that it's still going. And going and going. And the top "BROKEN" news story is clearly our still-broken economy. Here's some supporting evidence:
Only 88,000 new jobs were produced last month, and the only reason the unemployment rate ticked down to a still-alarming 7.6 percent is because so many people left the work force altogether, which sent the labor force participation rate down to 63.3 percent, the lowest point since 1979. If we were to include in the calculations those who have given up looking for work, the unemployment rate would actually be 9.8 percent.
As of February, there were 12 million workers officially unemployed, but only 3.9 million job openings, which means a little over three unemployed job seekers for every open job. And of the nearly nine million jobs lost during the recession, only about six million have been recovered, leaving us with nearly three million fewer jobs than we had at the beginning of the economic downturn. At the current rate of growth, we're not due to get back to full employment until around 2020.
And even for those who have found jobs, it's still a "BROKEN" story. As Jed Graham of Investor's Business Daily writes, "As bad as the current job recovery has been -- and it's by far the weakest since World War II -- the recovery in wages has been far worse."
Graham notes that in the last recession, in 2001, the wage recession lasted only two and half years, much less than the four-year jobs recession that accompanied it. In that recession, at the point where we are now, relative to the start of our current recession, wages were up 8 percent over their previous high. But not this time. Graham cites a study last year that found that low-wage jobs made up 21 percent of this recession's losses but a whopping 58 percent of the recovered jobs. Which is one reason why real annual median household income continues to fall, most recently to just over $45,000 -- down from around $51,144 in 2010.
As Brad Plumer put it, "America's middle-class jobs have been decimated since 2007, replaced largely by low-wage jobs." And this is a "BROKEN" news story that keeps on breaking. According to the Federal Reserve Bank of San Francisco, when middle class workers lose their jobs and find new ones at lower wages, over the next 25 years they'll earn an average of 11 percent less than workers who kept their jobs. And since our so-called recovery started, almost 40 percent of new jobs have come in low-wage areas like food service, retail and clerical jobs.
For the long-term unemployed, the situation is verging on hopeless. According to The Atlantic's Matthew O'Brien, the long-term unemployment picture is "the scariest thing in the world." It's an alternate economy, he writes, that's "horribly dysfunctional" -- and comes with consequences for the entire country. "The worst possible outcome for all of us is if the long-term unemployed become unemployable," he writes. "That would permanently reduce our productive capacity."
In fact, given our lack of recovery so many years after the start of the recession, that permanent reduction might already be happening. In the last quarter of last year, our actual GDP was around $975 billion less than the potential GDP our economy has the capacity for. Nearly a trillion dollar gap.
In that context it's not that surprising that there are currently 46 million Americans living in poverty, over 16 million of them children. "Yet," as HuffPost's Jennifer Bendery writes, "the issue has all but disappeared from the legislative agenda in Congress as lawmakers focus squarely on deficit reduction. Obama, too, has been largely silent on the issue, and has even proposed cutting Social Security -- a key tool for combating poverty." To Rep. Marcia Fudge, an Ohio Democrat who is also chairwoman of the Congressional Black Caucus, it's "unfathomable" that the issue isn't "at the top of everybody's priority list." Though it's a bit more fathomable when it's not at the top, or even the bottom, of any of our Sunday news shows.
Of course we could make taking on poverty and the jobs crisis a national priority; but instead, the parameters of the ongoing economic debate -- which the media play an important role in setting -- are largely confined to how big of an austerity hit we're going to impose on ourselves. According to the CBO, the sequester and payroll tax hikes could cut growth by 1.5 percent over the course of this year. "Unless the government takes steps to boost growth, we will be seeing millions of people needlessly denied employment for over a decade," writes Dean Baker. "That should be the central focus of everyone in Washington."
Including the media.
But it's hard to imagine our jobs disaster will get the attention -- and the solutions -- it deserves if our media doesn't think it's a story worth telling. I know it's not "BREAKING NEWS!" but it's "BROKEN NEWS" to the tens of millions whose lives are still being turned upside down by it.

Self-Care & The Work-Life Balance...Are We Kidding Ourselves in the Behavioral Health Arena?

I spend a good chunk of time in presentations and during the delivery of technical assistance trying to convince people that the notion and promotion of self-care and a balance between one's work and personal life is not just important, it's critical to the overall well being of an individual. Most of us know that "all work and no play makes Jack or Jill a very dull person." We know that burnout within the field of healthcare, and especially within the subgroup of behavioral healthcare, is the number one factor people leave the field.  We all also know that within the behavioral health field vicarious trauma, re-traumatization of our own personal lived experiences, and compassion fatigue are always lurking possibilities for us.

Yes, we definitely know all of this, but years ago when I started working fulltime as a direct service provider instead of being a "service recipient," the issue of self care was damned near an afterthought, usually tacked on to the end of a daylong workshop or mentioned in passing as we all discussed the pressing issues of the day for us.

Sure, there were some real forward thinkers in my field who, back then, were pushing the idea of "managed and intentional" self care, but even they were usually relegated to the end of the day workshops and presentation slots, so that they were often presenting to more empty chairs than human beings, as folks lit out for airports or raced to beat rush hour traffic back to their offices.  That so many chose to go back to work rather than heading home should say volumes about the overall impact we were having with the message of self care.

We in the behavioral health world today are doing a much better job in promoting self care and work-life balance.  Lots of resources, trainings, and information are now available.  We even incorporate wellness into our training agendas as a normalized course of action to be done along with outreach, case management, supervision, and service delivery in general. Woohoo!

I'm not sure however, that we're practicing what we're preaching.

Consider that for most of us, a 9 to 5 job is such a fantasy as to be almost laughable.

On reason is that folks dealing with homelessness, addiction, and/or mental illness, do not have challenges and problems that only occur during normal business hours. Providing emergency services, locating folks who may be holding down day labor jobs or are out doing other things like can collection, selling street papers, etc., are hard to find, harder to engage when they're engaged already in survival mode, and then disappear during evening hours to places they've discovered that can be friendly - or at least tolerant - to their plight.

Another reason is just the sheer damned volume of  work that lands on our shoulders (and yes, I do realize I've repeated this yet again).  The vast majority of our workforce in this arena are deeply caring, compassionate, driven people who realize that homelessness kills.  While we may not be providing advanced medical care to those experiencing acute life threatening emergencies, we know that we are many times working with those who are seriously and chronically ill, as well as with those who live in such dangerous conditions that death is a very real possibility on almost any given day, and we take our mission to help end homelessness very seriously as a result.

Finally, it's the sheer volume of work - and yes, I realize I just mentioned that, but it's so damned important that it deserves a second mention. The work is never-ending and increasing by the minute. As budgets are slashed and the sequestration idiocy continues, homelessness increases and staff to assist those experiencing life on the streets decreases. Technical assistance to support those staff members in obtaining the best training and newest strategies also decreases, making providers' jobs more challenging and eliminating the benefits to our clientele that come from better training.

A big part of the problem seems to be that we're continually provided with less to work with - staff, resources, time, money - and at the same time, we're asked to do more.

Those who wonder why we're forced to work 50, 60, 70 or more hours each week look around themselves, see all their colleagues doing exactly the same thing, and then are reluctant to complain for fear of being branded as one who does complain, one who cannot "handle this work," one who should probably look elsewhere for employment lest she deteriorate further morale that is already often low because of the sheer volume of work and the incessant, screaming need of those who require our services in the first place. There is a sense of resignation and a refusal to appear "weaker" than our colleagues; "they're doing it without complaint and they do it every day.  I guess this is 'the norm.'"

Modeling of the work-life balance really comes from those who lead us. When we see our supervisors, our senior staff, our leadership teams emailing staff at 5am or 10pm, when we walk out the door at 6pm after a 10 hour day and our supervisors are still chained to their desk, laboring away, the message of work-life balance and self care are not in sync with the actions of those individuals we employees look to for guidance, mentoring, and leadership.  Worse, the message to many of us is that in order to "get ahead" and advance in our careers, this incredible demand on our time will only increase as we take on additional responsibilities.

In these days of extremely scarce resources, the competition for them is fierce, and agencies and organizations, just like the employees who make them operational, recognize that if they're going to compete, they're going to have to do more with less in order to remain competitive. Agencies respond to Requests for Applications (RFAs) in the hunt for elusive grant money knowing damned good and well that dozens - if not hundreds - of other agencies are doing the same, and we know that in order to be successful not only do we need to write an effective proposal, we've got to overpromise AND overdeliver because everyone else is doing exactly the same thing.  The mentality here is that "some grant money is better than no grant money and if we get less, at least we keep some folks employed and get to ultimately deliver services, so whatever it takes we've got to be willing to do."

Doesn't take a nuclear physicist to figure out that this is a recipe for very long and sustained workweeks.

We know too that those who work at this frenetic pace, day in, day out, over weeks, months and years at a time aren't long for this field.  It's why behavioral health professionals suffer burnout and compassion fatigue at unbelievable rates, and the best and the brightest in our field often suddenly disappear under the weight of retraumatization, vicarious trauma, stress-related maladies, and a hopelessness instilled by the knowledge that we'll never be able to see the light at the end of the tunnel, let alone actually enter into the daylight of a job that has left the tunnel completely.

I'd like to offer some solutions here rather than to simply articulate the challenges. I can offer up some good resources and some really worthwhile exercises and recommendations that come with solid evidence to support their efficacy.  But all the resources and training and cajoling and discussion we can throw at self-care and the work-life balance are frankly worthless if those we look to for modeling, mentoring and guidance aren't practicing what we're being told to preach.

Affordable Care Act: News You Can Use

I work with many others at the federal level in preparing states for the coming open enrollment period to obtain insurance coverage mandated by the Affordable Care Act (ACA/"Obamacare") beginning in October, 2013.  It took many long nights of reading before I could even begin to grasp what was included in this Act and I continually look for easy to understand breakdowns of the information contained within it.

The ACA has a lot of moving parts and some of it can be incredibly challenging to understand, even for the brightest among us.  The Agency for Healthcare Research and Quality thankfully have been able to wade through it and bring us information that is both relevant and useful for we, the common folk. Check out the column below by Dr. Clancy, and then visit the AHRQ website.  You'll find a lot of useful info there that can help in understanding what the ACA is and how you can benefit from it.

Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

AHRQ Director Carolyn Clancy, M.D., has prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They will address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan. Check back regularly for new columns.

Apr92013

Health Law at Three Years Highlights Coverage, Cost, and Quality Improvements

By Carolyn M. Clancy, M.D.

When the Affordable Care Act was signed into law 3 years ago, many Americans paid attention to popular features like letting young adults stay on their parents' health insurance until age 26 or closing the "donut hole" gap for Medicare prescription drugs.

These portions of the health care law help a lot of people.

As of December 2011, 3.1 million more young adults had health insurance coverage as a direct result of the law, according to a national survey from the U.S. Department of Health and Human Services (HHS). Gains in coverage among young adults took place in every State. Big jumps (over 75,000 young people) were seen in California, Florida, Georgia, Illinois, Michigan, New Jersey, New York, and Texas.

And starting in 2011, the health care law gave an automatic 50 percent discount on brand-name drugs to Medicare patients who hit the "donut hole." (The donut hole refers to a coverage gap that happens once a patient's drug plan hits a certain limit in a given year. After that point, the patient has to pay all costs for covered drugs on their own for the rest of the year.)

In 2011, the 50 percent brand-name drug discount helped patients get more than $2.1 billion in savings, or $604 per person, according to HHS. (The law changes the brand-name discount each year until the donut hole is closed in 2020). Some patients who had high drug expenses got rebate checks from HHS for $250.

Other parts of the health care law aren't as well-known, but they also are working to make sure your health care is high quality, safe, and affordable.

I'm particularly excited about one part of the law that is working to keep patients from returning to the hospital soon after they are discharged.

Each year, about 1 in 5 Medicare patients, or 2.6 million seniors, are readmitted within 30 days after they've been discharged from the hospital, a major study     found. Being readmitted to the hospital can slow down a patient's ability to recover or can cause new health problems. This is very expensive, costing the Medicare program about $17 billion per year and causing unneeded problems for patients and families.

Just as worrisome, many of these readmissions can be prevented. Often, patients recover when they understand how to take any new medicines they've been given and schedule follow-up appointments.

For example, patients might go their emergency room if they have a bad reaction to new drugs, if there was a miscommunication about medication, or if they could not get to a follow-up appointment with their primary care doctor. Patients need – but don't always get—follow-up care that's better coordinated across the entire care team, including physicians, nurses, pharmacists, physical therapists, and other health professionals.

The Affordable Care Act is working with hospitals with high readmission rates to improve. Hospitals with high readmissions for three conditions (heart attack, pneumonia, and heart failure) now get paid less than hospitals with fewer preventable readmissions.

And we're starting to see positive results .    In 2012, the national rate of hospital readmissions for Medicare patients dropped to about 17.8 percent, compared with 19 percent for the past 5 years. This drop translates to more than 70,000 preventable readmissions each year.

In addition, the Agency for Healthcare Research and Quality (AHRQ) has funded the development of tools to help hospitals reduce preventable readmissions. The tools include a free brochure for patients and families called Taking Care of Myself: A Guide for When I Leave the Hospital that is available in English and Spanish by calling 1-800-358-9295.

Our ability to reduce hospital readmissions has never been higher, which is good news for patients.

In its 3-year history, the Affordable Care Act has made big strides in expanding coverage, reducing costs for patients, and improving safety and quality of care. While plenty of work remains, it's exciting to see how far we've come.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Navigating the Health Care System: Helping You Avoid Return Trips to the Hospital
http://www.ahrq.gov/news/columns/navigating-the-health-care-system/20120904.html

Re-Engineered Discharge (RED) Toolkit
http://www.ahrq.gov/professionals/systems/hospital/toolkit/index.html

Taking Care of Myself: A Guide for When I Leave the Hospital
http://www.ahrq.gov/patients-consumers/diagnosis-treatment/hospitals-clinics/goinghome/index.html

U.S. Department of Health and Human Services
Healthcare.gov
State-Level Estimates of Gains in Insurance Coverage Among Young Adults
http://www.healthcare.gov/news/factsheets/2012/06/young-adults06192012a.html

Healthcare.gov
Stronger Benefits for Seniors, Billions in Savings This Year
http://www.healthcare.gov/blog/2012/05/medicare052412.html

Centers for Medicare & Medicaid
Community-based Care Transitions Project
http://innovation.cms.gov/initiatives/CCTP/?itemID=CMS1239313

Health Affairs
The Affordable Care Act At Three: Paying for Quality Saves Health Care Dollars
http://healthaffairs.org/blog/2013/03/20/the-affordable-care-act-at-three-paying-for-quality-saves-health-care-dollars/    

Jencks SF, Williams MV, Coleman EA. Rehospitalizations among Patients in the Medicare Fee-for-Service Program. N Engl J Med 2009; 360:1418-1428.

Ego Creep

Channel 5's Nick Beres helps raise awareness for the plight of
homeless camp members 

People who work serving the needs of those experiencing homelessness are a unique and special group of people.  We aren't very plentiful because the work is damned hard, often terribly unrewarding, with far more failures than successes, and no one will ever ever ever become rich, or even frankly achieve lower middle class status, on the wages paid to homeless service workers.

When people in our very challenging work arena begin to think that only they can provide or perform a particular service, or only they know what's "best" to serve the population, it should ring very loud warning bells that alert them to ego-creep.

Ego-creep is a phenomenon wherein a provider or an advocate becomes convinced that only they are able to provide the "protection" of human rights, ensure the safety, and provide the services necessary for an individual experiencing homelessness to be able to extricate themselves from their current situation.

Ego-creep often has its roots in the disillusionment of the affected individual's perception that the "system" they're working in (behavioral healthcare, social services/affordable housing, law enforcement, etc) and/or the people within that system have ultimately failed - for whatever the reason - to adequately provide necessary and/or appropriate resources and services for vulnerable populations.   Many times, the affected individual engages in personal crusades to "right the wrongs" of the larger society, and comes to believe that they have the requisite skills, knowledge and abilities to both identify and to right those wrongs better than anyone or everyone else.

Initially, the dedication and commitment of those suffering from ego-creep often appears incredibly strong and bottomless, and they can sometimes be seen as "saviors" within the population they are championing.  This adoration and continual ego-stroking by those they believe they are serving reinforces the behavior, often resulting in an increasing expansion of their desire to "save the world." Those afflicted with the malady throw themselves into the passions of the day, work tirelessly to advance their cause(s) (it's rare indeed that the person suffering from ego-creep focuses on one priority only; another clear indication that the person is indeed suffering from ego-creep), and are often the "hard-liners"  who demand it is "their way or no way."

While the devotion to social justice is admirable, the ego-creep afflicted individual often ends up doing more harm than good.

Why? Because first of all, the needs and situations of the homeless are so complex and varied that no one person could possibly know and meet them all.   This narrow kind of "I know what's right" thinking is not only harmful to those they fail to serve because they're almost certainly missing important needs, it is also dangerous for those experiencing homelessness because the ego-creeper is single-handedly fomenting and perpetuating an adversarial "us versus them" mentality among the homeless population and the rest of the community.  There is enough of that already without them adding to the mix.  No matter how much time any of us have spent working on the streets, none of us "know it all," and we certainly cannot possibly know what the best approach or service need is for every single person out there.  To assume so only highlights the affected individual's ignorance of trauma informed, person-centered care, of the need and importance of cultural responsiveness, and illustrates a lack of professional capacity for serving the population we all profess to care so deeply about.

Image courtesy of:
www.digitalspy.com 

Second, thinking that many, if not all, of the people you come across in your daily wanderings - whether on the streets or in the camps - aren't known about by police is a very naive and dangerous assumption.  Take it from one who has worked closely with the cops at various times - both in a productive and helpful fashion and in direct opposition to efforts by them to close camps and harass those experiencing homelessness - many know far more than they let us know they know about where people may be squatting or the location of "hidden" camps.

One of the reasons I suspect  they often don't come sooner is because no one has "officially" complained about them yet, and believe it or not, many officers do indeed understand the lack of housing availability in communities.  Remembering that police often typically default to their police "training" and enforcing the law - because that's what we pay them to do  - goes a long way in figuring out when to work with them and when to assist in advocating for your clientele. It is definitely true that there are times when we simply cannot trust police with some of the "location" information, but we cannot build a working relationship established on trust and respect if we don't engage with them.  At the same time, we have to realize there are times when they have discretion and times when they're mandated by their job to act. We cannot hold their actions against them, so long as they do that job with an eye toward "protecting and serving" rather than "harassing and intimidating."  Therefore, we to must also exercise discretion in our interactions with them, but we must advocate for the former while speaking out against the latter.

The goal should be about working as closely as one can with all members of one's community, including the police whenever feasible, while also maintaining the confidentiality and security of those you're serving. In the end, it's always about developing relationships, raising awareness (like the Nashville Homeless Power Project did when it provided regular sensitivity trainings to the Nashville police department), and most importantly bringing multiple options via multiple providers. In today's environment of slashed budgets and dwindling resources, it is fast becoming the only way we can provide an array of resources, always with an eye towards ultimately procuring affordable, supportive (when warranted) housing to those on the streets and within the camps.

And of course this is not done indiscriminately, with gangs of roving social workers trampling through the homes of individuals who may be residing in camps or in the bushes right under our noses, then running to local police with privileged information on the whereabouts of our clients. These engagements - especially in camps - are appropriately done by invitation, and to get an invitation means first building a relationship built on trust and respect.  For those outreach workers who've built that credibility within the population or a camp, it's not a "prize" to be lorded over others, bragged about in meetings, and used as proof of how good an outreach worker they are, it's a relationship one utilizes to ensure that the appropriate, competent, and helpful direct service providers in the community can benefit from right alongside those who need the services.

If the concern is that these kinds of direct service providers are hard to find in the community, welcome to the world of working with human beings. A secondary but just as important role as a champion of direct service provision to vulnerable populations is educating and raising awareness of a trauma informed, person centered approach to those who appear to be deviating from it.

Third, alienating those who care just as deeply about serving the homeless as you do by withholding information about where to find and engage people experiencing homelessness is frankly counterproductive and diverts precious scarce resources from those vulnerable individuals with the most pressing needs within our community.  While the ego-creeper may think that only he/she is "sensitive" enough, "caring" enough, or "smart" enough to understand the astounding array of services and needs every individual you meet has, they would not only wrong, but dangerously insensitive, egotistical, and I would have serious reservations about their ability to perform the duties required of street outreach specialists and case managers.

Direct service providers are modeling both behavior and the power of community collaboration and responsibility to those on the streets.  One of the most significant challenges vulnerable populations face is the power differential between provider and recipient of services. One of the goals of a recovery-oriented system of care is to remove the power differential by empowering those who require services while ensuring they have equal access to any and all the services they require and empowered sufficiently enough to make the appropriate decisions based on their needs. A true advocate doesn't withhold collaborative engagements and the introduction to people who might be able to assist. Instead, they accompany the individual and support them through the process, advocating on their behalf and intervening with the other provider when necessary to help clarify, and further understanding of the client's needs and background.

By acting as the sole source of their "service delivery" the ego-creep afflicted individual is not only wielding incredible power over them because he/she dictates who receives those services by forcing individuals to come to them to even find out about what services are available, they are also modeling to the person experiencing homelessness the very behavior they profess to abhor as they endeavor to obtain services for them.

The goal should be an integrated system of care, an open system of information sharing so that workers every bit as committed as the ego-creeper have at least some access (unfiltered -and if possible actively facilitated - by the advocate) to the population so desperately in need of those services. Instilling distrust throughout the homeless community by acting as the only "legitimate" access to those services smacks of selfishness, ego, and illustrates a troubling internal need for power and control over a very vulnerable group of people.

If the ego-creeper truly cares about those they serve, they will realize the futility of trying to serve them all, by themselves.  Not only are they keeping many from access to the services because of their ignorance, they're also well on the way to burnout, which is the number one reason direct service providers leave our field.  A lose- lose proposition for the dedicated ego-creeper, for the field, and for those who need us the most.

I know the ego-creeper's heart is in the right place and their goal is to serve those who need support and assistance.  I think they also realize they will never be able to meet all the need that arises in their daily engagements with folks on the street.  Trusting in the relationships they've built and nurtured with the direct service providers in their area and their fellow outreach specialists will go a long way in ensuring that extremely scarce resources - and getting scarcer by the day - will be better utilized.  Better utilization of those resources means more individuals served, and in the end, isn't that what everyone, including those suffering from ego creep, really want anyway?