About 3 months ago (wrong! That should tell you how long I’ve been writing this post- it’s now been 8 months!), I stopped working full-time in the ER* and shifted to supplemental coverage in order to do outpatient therapy. Also, it was because I hated overnights and holidays and weekends, which turns out to be what life is like in an Emergency Department. But I like the work, and it keeps my disaster mental health skills sharp. So now, a very small (read: balanced) portion of my professional life is spent in the ER.
*You thought I was only part-time? Me too, but we were critically understaffed for my entire ER career and worked things like 96 hours in a pay period for a number of months.
Now my professional life is a buffet of mental health services, constructed at the whim of a kid. Imagine one of those magicians who whips up a giant castle out of cards in 3 seconds flat, then stands aside and flashes a smile. Pling! (that was the sparkle in the smile). That’s me. With mental health cards. Most afternoons.
Indiana (and 10 other states) have this strange little grant designed to keep kids out of psych facilities. The grant allows a team of providers to be selected at random from a pick-list, and then interviewed by the family and chosen based on professional qualifications like “Is she younger than 30?” or “Does she like Selena Gomez?” or “How many pets does she have?”. The real confusing part cherry on top is, the kid who’s picking you is, like, bipolar. So it sort of depends on how everyone is feeling that day.
On some of these teams, I’m interviewing to provide Emotional Habilitation, like coping skills, or Rec Therapy. On other teams I’m interviewing to provide Clinical Consultative therapy to the family and team members, like behavior plans. I look good on paper for the adults, and I wear glitter nail polish for the kids. That’s my strategy.
My first interview last April was in the bag. I put on my sparkly-est silver nail polish and graphic T, and knocked on the door with a smile. 15-year-olds generally love me. Interviews are sometimes a formality anyway- many times a family will pick only you off the list, interview you, and then select you. Other times, they interview multiple providers, and the case manager calls you later with the yay or nay. I knew I was interviewing against 2 other providers for the Hab role, I just didn’t know I’d be interviewing with them at the same time. A panel interview scripted and moderated by a 15 year old:
Kid: What kinds of things do you like to do?
Me: Eat candy and ice cream. Buy gifts for kids. Have pizza parties. Just kidding. Take walks, be outside, photography, play basketball…
Client: you play basketball?
Me: Yes! Do you like basketball? I can teach you to play. I also like to swim… (score!)
Client: Swimming?! I love swimming! Do you go to that one park?
Me: Yes, I love going to that one park. (score!)
Client, to second panelist: do you play sports?
Second panelist drops her head: No, I mean, not officially. I was kind of one of those people who played, like every sport, but wasn’t good at one specific sport (defeated!)
Client, to second panelist: do you have any pets? I love animals. I want to be a vet.
Second panelist: Yes! I love animals too! I have a service learning and therapy dog. You could go with us to volunteer at different places.
Pause.
Client turns to me: Do you have a therapy dog?
Me: stupid. stupid. stupid. Why didn’t why buy a dog? Should I say we have one? We almost have a Yorkie. Is that the same as actually having one? “No, we really want to buy a little Yorkie. But I just love therapy dogs.”
Client, to second panelist (as they walk off in the sunset holding hands): So what all can we do with your service learning dog?
Like I can compete with a service learning dog?!
Lucky for me, Radio Disney is pre-set in my car and saved me during the next interview, in which I was asked to perform Selena Gomez “Who says?” on command. It happens that I know the words. She gave her mom the thumbs up, interview over. I’m in.
But that’s just the preliminary process, because unlike sales, once a client selects me as a provider (or, for DCS contracts and outpatient clients, once they’re assigned to me: cold calls)- they have to actually spend time with me. Learning mental health skills. Like, for 1-2 hours at a time, multiple times per week. This means every week, I have to re-pitch the idea that mental health is important, that positive coping and anger management, or appropriate parenting and healthy relationships, or completion of ADLs and positive self-talk, or not biting your autistic sister, or becoming sober, are all worthwhile things to invest time in. And I have to make it fun! Here comes the tap dancing, because if they don’t meet with me, I don’t get paid.
So, you might see me traipsing around town with a gallon bag of 85 mini play-dos. I may have pixie sticks hanging out of my pocket. Essentially, I’ll be traveling across several counties, knocking on people’s doors saying: You need this. And in my brief case (messenger bag) will be emotions identification and social coping activities between harmless coloring pages and little packets of goldfish grahms. I’ll sit down and spend a good chunk of the hour building a relationship. And then I’ll move in for the ask: So, it seems like you could sort of feel your anger signs coming yesterday. Should we write them down, so you know what your triggers are for next time? Yeah! Let’s write them down. With markers. And stickers. Score.
Or, for my adult clients: So, it seems like a budget would be helpful. Do you want to complete a budget? And they look at me like, yeah! Yeah, let’s do a budget. And I’m like, Oh look, I just happen to have one right here in my folder. Score.
The real hard ones go like this: I know you’re going to hate this, but you signed this goal sheet that says we’ll talk about such-and-such trauma. They (the state) will not let you out of your contract (give you back your kids) until we somehow work through this…
Or: I know this is the worst, but remember when you signed that sheet of paper saying you understood the limits of confidentiality, and how one of the exceptions to confidentiality is if you told me someone was hurting you, or that you felt like hurting yourself? (Each, weekly occurrences). I have to tell someone. But you can sit right here next to me while I do it, and you can hear everything I disclose to: (CPS) (The Stress Center) (Custodial Parent)…
There are moments and entire days when I feel like an asshole- not like that one time I played hangman with a suicidal 7th grader on the first day of my internship in NOLA. No, not like that. But close.
My saving grace: there hasn’t been one person- not even the chick who was terminated for discontinued use of heroin, or the chick whose kid was removed because her partner fractured the kid’s skull, or the kid who got checked into the stress center against her will, or the dad who got arrested due to neglect of the kid who got checked into the stress center- every single person contacted me later: “You were the only one who treated me like a real person, Brooke. I mean, I know I got problems, but you were always cool. Thanks.” You can’t fake caring about a person. You either care, or you don’t. Rule 1 in helping profession grad school.
So, I might pull out of the driveway in the morning and yell to Jeff- I have a big account to nail today! (Translation- I’m interviewing with a client who has 18 hours per month! or I’m seeing this chick who no-showed me twice last week!) And when I get home, I sit in the car and evaluate my day like: well, I closed that one. That one needs a follow-up. Or usually: What’s my competition here? After-school activities? Heroin. Daggers.
But in the end, it matters, I think. And I’m selling a valuable commodity, mental health.
and you have a unique skill set…