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Why S.A.M.'s Kids

SAM’s Kids was created to address some trends in mental health and social services that make it increasingly difficult for families to get the effective services they need.  We will discuss these trends and the challenges they present.  More importantly, we will discuss our solutions to these challenges.  If you have any questions, comments, or suggestions please feel free to email us at info@samskids.org.

Much of this discussion will be focused on the mental health field, but the issues we will be discussing affect many special needs and/or at-risk children that have not been labeled with a mental health disorder.  These children may need services but do not receive them from the mental health system due to a variety of reasons.  Demographic, attitudinal, financial, and bureaucratic obstacles keep many children and families from receiving needed assistance and support.

We will address three primary themes that make it difficult for children and families to receive the assistance they need.  The first will be what we call the “dependency culture.”  The second area we will discuss is the problem of money within the social service field.  The last will be the problem of inconsistency in treatment.

Dependency Culture

To explain the dependency culture we must first identify the process by which children with challenging behavior get labeled.  In our mental health system children get labeled with a diagnosis of a disorder.  The tool used to identify a disorder is the DSM IV, the Diagnostic and Statistic Manual of Mental Disorders.  In this manual, there are lists of criteria that must be met for a diagnosis (label) to be identified.  The important item to note is that this diagnostic criteria is a list of behaviors.

Whether or not the problem is chemical or developmental, if you display the behavior you can be tagged with the disorder.  The problem with this process is that when people are told that they, or their child, have a disorder, their attitude towards the behavior may change.  It becomes much easier to blame this disorder as the problem rather than doing the work required to overcome the behavioral challenge.

The danger is that we may accept certain behaviors as “normal” for someone with this disorder.  This then empowers the disorder/behavior.  Our schools can exacerbate this problem.  The responsibility for the school is to educate the child.  Because of this they may circumvent the disorder in order to educate the child.  While our schools are successful in educating the child this process continues to enable and empower the child’s condition.

We may be successful in creating an environment in which the child can be successful.  The problem is that we have limited future opportunities by creating a situation where the child is dependent upon an adjusted environment rather than learning the skills necessary to be successful in any environment.  We have enabled and empowered the “disorder” rather than empowering the child to overcome this challenge.

This enabling leads to a dependency upon assistance to be successful.  To understand why we have developed systems that encourage this dependency we must understand the principles that are being taught in the social service field.  Sociology 101 is one of the foundation courses for social science.  The textbook for Sociology 101 at our local community college is “Sociology in a Changing World” by William Kornblum.  In Part one, Chapter one, Section one you are told that you will need to develop what is called a “sociological imagination.”  The following is a quote from that section.  “The sociological imagination can help us avoid blaming ourselves needlessly for the troubles we encounter in life.”  That is a powerful statement and the foundation for a dependency culture.  Part one, Chapter one, Section one.  You are not responsible for your troubles.

At SAM’s Kids we do not follow this dependency philosophy.  We believe in the wonderful potential of everyone, even those who have behavioral challenges.  The foundation of our programming is accountability.  We teach our children to be accountable not only for their actions but for their issues.  We work to empower them with the belief that their challenges are obstacles to overcome, or even strengths to be utilized, rather than handicaps that will limit them.  Our primary objective is to develop self-efficacy rather than a victim stance.  We want our clients to understand that they have the ability to change their results rather than being victims of their “disorder.”

Money

The next area we will discuss is the problem of money within the social service field.  The first note of interest is why we go through the process of labeling a list of behaviors as a disorder rather than simply addressing those behaviors.  Yes, money.  The diagnostic codes found in the DSM IV are used by the insurance companies to determine whether or not they will fund treatment.  So, having a diagnosed disorder can become a requirement for receiving treatment.  And working with a client who has a diagnosed disorder may be a requirement for a therapist to receive payment for that service.

A diagnostic code for insurance purposes is only one of the impacts that money has on the social service field.  We will discuss a number of issues that impact both our public and private mental health systems.  These will include what we call “gate keeping”, the “shell game”, an increasing bureaucracy, and a fee for service environment.

Gate Keeping

One of the challenges for families who need services is “gate keeping.”  Gate keeping takes a variety of forms but is existent in both the public and private mental health systems.  The primary purpose of gate keeping is to limit cost.  The existence of managed care in both the private and public sector is one example of this.  But there are a number of bureaucratic layers that accomplish the same task.  By increasing the hurdles to acquire funding for a service you effectively reduce the overall cost of providing those services.  Individuals may decide that it is too difficult to acquire needed services and agencies may determine that it is not cost effective to provide those services.

Unfortunately, gate keeping is a necessity.  With either public or private funding there are a finite amount of resources available, so ensuring that those resources are used most effectively is important.  And there are individuals, and agencies, that may look to acquire funding for services that are not needed. 

The troubling reality of this is that the person who receives services is not always the individual who needs them the most.  Being persistent can be as necessary as being in need.  Learning how to work within the “system” and navigating though the “gate keepers” is an important skill for the parent with a challenging child to acquire.

Another obvious result of gate keeping is the added levels of bureaucracy on both the service and funding sides.  Both sides need ever increasing numbers of administrative personnel to work the system.  This causes a drain on resources as more and more funding goes into the bureaucracy rather than into service.

Most of us are familiar with gate keeping within the medical field.  Working to get your insurance company to pay for services and doctors accepting one form of insurance or another because of difficulties getting payment.  These are all examples of gate keeping and these are challenges within the mental health system as well.

Shell Game

We are all familiar with the shell game.  You take three shells and one nut.  You place the nut under one shell and then mix up the shells so that the person can guess under which shell the nut is.  This is very similar to how funding for these services can work.  There are a variety of programs available for families and a variety of funding streams available to programs.  But figuring out what is available and whether or not you qualify can be challenging.  And for the program, maintaining the funding can also be challenging.  As political environments and attitudes shift and change this process can become increasingly frustrating.  Gate keeping also comes into play as the medical necessity criteria can be continually changed so it becomes increasingly difficult to determine who qualifies for what.

The shell game is, in its purest form, another type of gate keeping.  By creating an environment in which locating and maintaining funding is challenging we are able to limit the use of a finite amount of resources.  Unfortunately, the people who locate the funding are generally the best at navigating the system rather than those who need the services the most or those who provide the best service.

The biggest problem with this shell game is that it is ongoing.  After you find the nut it is simply placed under another shell and mixed up again.  Those in the social service field understand this process and are constantly making adjustments, changing delivery models, or offering new services.  This can be extremely frustrating for providers but that is not the problem.  The problem is that there are constant situations in which families have services discontinued or interrupted due to these changes.  What is an irritant to those in the field can be destructive to those who need assistance.

Bureaucracy

Similar to gate keeping, the shell game also creates an increasing need for bureaucracy.  More and more administrative staff are needed to navigate through the gate keeping and to stay ahead of the shell game.  These needs combine with increasing privacy and legal concerns to create an ever-increasing bureaucracy.  While it may appear to be good to have plenty of support for service delivery the problem becomes obvious.  More and more resources are being put into the bureaucracy, which means less goes into service delivery.  There is also a type of brain drain that takes place in which the most educated and trained staff move up the chain because they are best prepared to navigate through the gate keeping.  This takes your best-trained, most experienced staff and places them into the bureaucracy rather than providing services.

Fee for Service

Another challenge is the fee for service environment that exists in the mental health field.  Fee for service means that professionals are paid for the time they spend with the client.  The difficulty this creates is that there are often a number of professionals who work with a given child or family.  The rates for service are determined by the amount of time that is spent with the client.  However, an important part of effective treatment would be communication between everyone involved with the child.  The fee for service environment does not accommodate this need.

Inconsistencies in Treatment

This lack of communication between the professionals and/or agencies involved in a situation can create confusion and conflict.  There are many agencies that work with children and families with challenging issues.  These include the Department of Social Services, Department of Juvenile Services, Board of Education, Mental Health Administration, Local police departments and hospitals, and numerous private mental health and social service agencies.  Each of these agencies has a different objective and a different approach.  The lack of communication within this system combines with inconsistencies in approaches and philosophy and creates conflicting messages.  This confusion can often make a situation worse.

Reaction Time

A large problem created by all of this is that our social service system can be slow to react towards helping families.  All of the gate keeping, shell games, lack of coordination, and confusion creates a system that is slow to react to problems.  Getting services from any of these agencies can be time consuming.  Plus, if you determine that the level of service is not sufficient and need a more intensive, or less intensive, service then the time between identifying the need and implementing the service is extensive.  Often, by the time you get a service in place you recognize that you no longer need that service and the whole process starts over.  The bottom line is that more and more money gets poured into a system but if you ask families in need, you will find that finding sufficient and effective services is becoming more and more difficult.  If you talk to people who work within the system they will be able to identify these challenges.  The problem is in the correcting of them.

SAM’s Solutions

The most obvious problem that runs throughout this discussion is the effect of money on the services that people get.  Those in the field will often talk about the unfortunate reality that money is the key.  The bureaucracy that is created to handle the flow of money between those who fund services, those who provide services, and those who utilize services, creates an even larger drain on already limited resources.  We all know that money is a problem, so the obvious solution would be to remove money from the equation.  Of course recognizing this and accomplishing it are two different realities.

To accomplish this SAM’s will need to become self-sufficient.  To be self-sufficient we will need a renewable funding source that will allow us to provide our programming without the possibility of interruption.  To accomplish this task we have developed a fundraising department that will focus on building an endowment.  As this endowment grows we will be able to provide more and more services without the threat of interruption.

While this fund grows we will attempt to find alternative sources of funding within the community.  This is a community issue and one that Frederick County as a whole will need to address.  We are a Frederick County charity and we are working on improving the future for Frederick County youth.  So we will work to develop partnerships throughout Frederick County both with individuals, businesses, other agencies, and corporations that do business here in Frederick County.

One layer of this partnership will be our resource committee.  Please visit the page on our resource committee to find out more about its function.

The second layer will be local businesses that would like to support us with our mission.  These businesses can help in a variety of ways including sponsorships of events, scholarships for families, or sponsorships of programs.  An important aspect of this partnership will be that our resource committee will also be aware of which businesses are supporting us and can patronize them in return.  This allows us to enhance our community partnership to allow everyone to help us help the children and families in need here in Frederick County.  This community partnership will allow us to both begin offering services to families while we simultaneously build towards self-sufficiency. 

The added advantage of removing money from the equation and working outside our current public and/or private mental health systems is that we can provide our programming at a fraction of the cost.  By eliminating the need for bureaucratic overhead due to circumventing the current “gate keeping” and “shell game” system we are able to reduce overall cost and focus a higher percentage of funding into direct service.  Instead of having the best-trained individuals moving up into the administration they will remain at the direct service level.  The administration becomes more supportive and less supervisory.  This flattening out of the bureaucracy both decreases cost and increases effectiveness of the treatment.

You combine this increase in ability of direct service staff with the treatment approach that leads to individuals becoming independent versus needing ongoing treatment, and you have reduced demand.  This reduction in demand again allows you to reduce the cost of treatment for each child and their family.  Thus, you can treat more individuals at a lower cost.

We also need to address the continuum.  SAM’s Kids will eventually provide a complete continuum of services.  Please visit the continuum of services for details. 

Having a complete continuum allows for a seamless, and time limited, transition for families into the level of service they need to be successful.  By having the complete continuum under one roof we also again reduce overhead by eliminating the need for new referral and admissions processes.  The admissions/transfer process would be handled by a case manager who would remain with the family through every level of treatment.

We hope that this section has provided you with an understanding of why SAM’s Kids is built the way that it is.  We also hope that you have an understanding of how our structure and programming will allow us to effectively help families in need acquire the services that will allow for their optimal chance at success.  For more information on how you can help please visit the resource committee page.

If you have any questions, concerns, suggestions, or want to pass along any information you feel will be helpful please contact us at info@samskids.org.