Is Transformation Over?
Raymond R. Ratke | August 5, 2010
I’ve gotten that question a lot over the last number of months. At first it was in response to the apparent lack of clarity on the part of the new administration in Richmond with regard to the initiative – would they make it a priority or would they not? But since I announced my retirement from state service I have repeatedly been asked; does this mean that the Transformation of children’s services is over?
Children’s Services System Transformation began with the idea that we needed to fundamentally change how services are provided to at-risk youth and families to achieve some basic goals – to keep kids and families together wherever possible, to help kids live and be successful in their home community and school, and to assure better life long outcomes for kids and families who come in contact with one of the child serving systems of social services, behavioral health, juvenile justice, and special education.
Achieving these goals appeared to require change in some essential ideas and ingredients in the basic practice of working with kids and families. Or did it? In fact, I believe that the Transformation of human services – for adults, children and families – more accurately involves returning to the roots of our respective professions. To a basic belief in and respect for the inherent goodness of people-even when they are at their most challenged and challenging. Starting where the person or family is. Actually listening to and developing service plans based on what people say they need – being truly person and family centered. Finding and building on strengths. Working in true partnership across systems. Living the ideal that people are best off when services and supports are provided as close as possible to an individual’s home, family, and community. Raising, rather than diminishing, hope.
These ideas are at the heart of the Practice Model that was developed as part of the Children’s Services Transformation. They are also at the heart of the “recovery” model in behavioral health, and the principles of services for persons with intellectual and developmental disabilities – self-determination, empowerment, and full participation in the life of the community. In fact, I believe they are the principles underlying of all areas of human services. We have made great progress – truly transformative progress – towards fulfilling the promise of the practice model. However, while there are certainly wonderful examples of transformed services in many localities across Virginia, it is also clear that we have a very long way to go. On a variety of fronts, the struggle to improve outcomes and help the people we work with lead better lives continues.
Recently, with the best intentions, many people have been congratulating me on my “retirement”. I have appreciated these good wishes but also admit to a sense of discomfort at the same time. You see, especially at this point in time in the struggle to improve outcomes for Virginia’s most vulnerable citizens, it is not the time to retire – it is not the time to be on the sidelines. In fact, it is time for increased action, for renewed dedication to implementing the values and ideals of the practice model, and for each of us to return to the same questions we asked since the beginning – do I care enough?, do I know enough?, am I doing enough?, and am I being persistent enough? It is time for a renewed sense of urgency and for renewed inspiration.
In this regard there is much reason for hope – for the power to provide services in a “transformed” way, the power to provide services that truly engage people, that expand hope and improves outcomes - lives in each of us. Instead of being over, “Transformation” is alive in every locality, every provider and in each person who commits to doing this work in a different way; to be truly person centered, to see the people we have the good fortune to work with as partners rather than adversaries, to stop finding only pathology and to start looking for strengths, to reach across human services agencies to work in true partnership, and to encourage hope and a bold vision of community inclusion and choice for all persons with disabilities. “Transformation” won’t be over until this is the rule rather than the exception and the power to achieve this vision rests in each of us.
Clear policy and direction from leadership at the top is important. But at its core Transformation has always been about culture and practice change in the actual work with people. While my role in influencing state policy is now limited, I am looking for opportunities to remain in the game and to continue to have a positive influence on the efforts of localities and providers to improve the lives of the people with whom they work. Toward this end, I have recently joined with a loose affiliation of consultants working in Virginia called, “Partners for Transformed Human Services (PaTHS). The mission of PaTHS is to improve life outcomes for people served in human services organizations through partnering with public and private providers, localities, state authorities, families, and advocacy organizations and by providing a comprehensive array of high quality professional consulting services that are based on core values and principles of Transformation. I invite you to check out Humanservicestransformation.com on the web and I look forward to the chance to join you once again in this very important work.
I love reading what you have written above, but wish it were a reality, not a dream, in Virginia. As a an uninformed citizen, this is what I imagined was already happening in Virginia. A family first policy, full of common sense, accountability, and financial frugality. Then my eyes were opened to the horror that is child and family services in Virginia. Families come last, there is no sense to the chaos, there is no accountability of any person, agency, facility, or corporation, and during a recession, when every penny should be counted and justified, we continue to waste millions of dollars annually on the one single service we know doesn't work for anyone, residential placements. And having committed to subsisting at the teat of the lobbyist and and their checkbooks, our legislators refuse to question what is happening when the state's own workers have documented years and years of patterns of abuse, neglect, child endangerment, molestations, rapes, and deaths of Virginia's disabled children in for-profit residential facilities paid $800 - $1,000 a day to "care" for these children. This is not a philosophical issues and does not need a new plan, what we need to do is start calling law enforcement and commonwealth attorneys whenever a child is the victim of a crime in these residential facilities. Rape is a crime, not a licensing issues. Young boys having anal sex with each other, on video, repeatedly, in public locations of a facility is child endangerment, it's a crime, not a staffing issue. And Virginia's dismantling of licensing staff under Kaine's administration assured even that oversight was minimal at best. My adopted son's experience in 7 years of Virginia foster care, the bloody slivers of bones sticking out of the compound fractures of his ankles, black hand print bruises from staff restraints across his arms, ankles and body, fractured teeth laying on the ground beside him as he lay on his back, choking on his own blood, screaming from excruciating pain, while facility staff held him in place until he agreed to meet their "requirement" to be silent for 5 minutes, then the staff theft of narcotics prescribed to him for his pain, this is the reality of residential placements in for-profit residential facilities in Virginia.
ReplyDeleteLowering residential placements a few percent a year just doesn't cut it. These are crimes and should be treated and prosecuted as such. And if nothing else, the simplest solution is less government intrusion, let the free market do the work now that Marilyn Tavenner and Dr. Reainhard are no longer in place to run interference and change documents for their favorite corporations. Free market requires an informed consumer and costs the government not a penny. Simply require, by the end of August, that all facilities post in a yellow folder in their reception area and online all of their licensing reports and investigations (fire, health, education, Dept. of Beh. Health, etc.) for the last five years and for that last 10 years for any founded violations or serious incidents. The reports are already redacted by licensing staff, so privacy is not an issue, except for the facility being embarrassed, but the corporations know how to fix that problem, do a better job! If self reporting through CMS works for infection rates, ("Making infection rates public is a powerful motivator for hospitals to improve care and keep patients safe.") we could easily make it work for abuse, neglect, rapes, and deaths in for-profit residential facilities in Virginia. Wouldn't it be amazing if Virginia took the lead with this one simple, not cost mandate by Governor McDonnell? And if anyone doubts how effective it would be, watch how hard Psychiatric Solutions Inc., Universal Health Services, and their puppet babysitters OCS and SEC fight this one simple, no cost, effective, suggestion for change. Just like they fought having more than two parent representatives on the State Executive Council, which also would have provided a simple fix for Virginia. Sometimes the simplest, least expensive solutions are the best.
ReplyDeleteSusan Lawrence
Lexington, Va
540-458-1245
"Keep An Eye On PSI!" (and UHS!)
http://www.facebook.com/group.php?gid=326364429203&ref=ts
New Regulations Cut Down Infections In Hospitals
ReplyDelete(If it works for infections rates, it can easily work for abuse rates)
http://pagingdrgupta.blogs.cnn.com/2010/08/02/new-regulations-may-cut-down-infections-in-hospitals/?hpt=T2
"Making infection rates public is a powerful motivator for hospitals to improve care and keep patients safe. This is an enormous victory for patient safety advocates who have worked tirelessly to hold hospitals accountable for failing to eliminate infections."
The new reporting requirements apply to hospitals that participate in the Centers for Medicare and Medicaid Services (CMS) "pay-for-reporting" program. According to the Consumer's Union, virtually all hospitals in the country participate because they earn a higher Medicare payment for doing so. During the first year using the regulations, Medicare payments will be based on how effectively hospitals are reporting infection rates. Beginning in October 2012, Medicare payments to hospitals will be tied to how well they protect patients from these infections and the quality of their patient care.
Starting in 2011, hospitals will be required to report to the CDC the number of people who develop bloodstream infections in their intensive care and neonatal intensive care units. The CDC estimates that patients develop more than 250,000 central line associated bloodstream infections each year while in the hospital.
Infection rate information for each hospital will then be posted later that year on the federal Hospital Compare web site.
The new regulations are part of HHS's five-year plan to reduce hospital acquired infections. The CDC estimates that the direct costs associated with hospital infections are as high as $45 billion each year.
Simple, straight-forward, and little or no cost to the taxpayer. This makes so much sense!
ReplyDeleteMs. Lawrence writes with knowledge, experience and
ReplyDeletepractical suggestions for overcoming problems that should never exist with the children in Va.
I've read her remarks before and I don't understand why someone doesn't seek her out for
assistance in taking care of these problems. She
obviously knows what she is talking about. Does
the State of Virginia even care????? I never read
or hear of this topic being brought up by politicians stating their position or suggestions. Why??