Index

Wasted monies in mental health and developmental disabilities treatment

Incentivizing Disability Instead of Wellness

Incentivizing Disability Instead of Wellness

Too often government creates an incentive for both children and adults to become and remain disabled.  This incentive comes in the form of financial payments, medical coverage, and various services, which in too many cases involving children equates to little more than babysitting.

While there needs to be a safety net, especially for the seriously disabled there are solutions for these issues as well.

1.       When payments are made for children, create a tiered approach with the parents/guardians of the most severely disabled receiving the monetary assistance with accountability for where the payments are spent and the parents/guardians of the less seriously disabled (but still eligible) receiving a voucher for specific payment related to the child’s disability.

2.       When the payment is for adults, the most seriously disabled need to continue to receive the monetary assistance with accountability for where the payments are spent and the less seriously disabled (but still eligible) having a stipend for expense with voluntary work obligations at or just below their capacity.  This could be as little as one hour a week.

3.       Services must meet the standards as outlined in the previous posting.

4.       While I believe that the current medical insurance law often referred to as Obama Care, should be deemed unconstitutional and is ruinous to the nation, we must find a way to provide medical coverage to more people with and without disabilities.  This can be done by states with the help of federal law to lower the cost of health care.  Too many people have too high an incentive to remain disabled just for the medical coverage.  For example: a man I worked with many years ago and who had severe Diabetes and who was on state assistance.  I helped him become employed and as his hours increased, he lost his financial assistance (no problem, he had his wages) then his hours increased further and he brought in more money and lost his food stamps (no problem, he had his wages) then his hours increased and he brought in more money and he lost his medical coverage.  (Big problem and enormous anxiety over covering the cost of his essential medical care.)  He was back on state assistance and soon on federal assistance as completely disabled.

Wasted monies in mental health and developmental disabilities treatment

While the monies spent in the United States on mental health and developmental disabilities treatment is only a very small piece of the federal budget it is still significant and symptomatic of a much larger problem found in many aspects of government.

Much of the treatment provided with federal dollars is either ineffectual or minimally effectual.  There are a number of reasons for this:

1)      When working with children, there is little permanent improvement without significant parental/guardian involvement.  This does not mean that the parent is bad; but quite often children with special needs need an environment which is different.  (I’m not saying that they need different parents; though on some very rare occasions they do; but I am saying that quite often they need their parents and their environment to be different and interact with them in different ways. Please see: http://www.collaboration.me.uk/CHILD_BEHAVIOR.php and http://www.challengingbehavior.org/do/pyramid_model.htm)

2)      Too many providers do not effectively adhere to evidence based practice with fidelity..and unfortunately we pay for it and those they are supposed to serve also pay for it through quality of life and personal productivity.

3)      Standard measures though standardized assessments are rarely used to measure real progress.  While there are a very few with degenerative disorders and who are not likely to make progress, we have a good idea who these are and the majority should make significant progress in at least behavior and many should make progress in functional ability as well.  Statistically we also know, on average who these people are.

4)      Too much of government focuses on the least common denominator.  Programs and the requisite paperwork are often developed for the slowest and most inept workers.  This reduces actual production and real progress significantly.  Many workers spend more than 50% of their time doing paperwork and less than 50% of their time delivering actual productive intervention.

5)      There is too much emphasis on process and output and too little emphasis on product and outcomes.  There is a pervasive culture within many parts of government which believes that activity equates with productivity and so continue to justify their programs with a great deal of activity without much to show for it in durable and meaningful results.  Too often all the supposed gains are erased within a year of grant/program termination.  This does not mean that the monies should have continued but instead tells us that the program was essentially ineffectual.