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Friday, December 23, 2005

By Susan B: O'Connell: What prompted my resignation

I am writing this as a follow-up to Mike Heine's article (The Week, Dec. 4) about the restructuring going on at Walworth County Health and Human Services.

I was interviewed for the article and would like to clarify my position on a couple of issues.

I was not interviewed by Ms. Maculan, but she approved my hiring.

My strengths were a 20 year history of providing mental health services in the private sector, knowledge of mental health, alcohol and drug services and treatment, awareness of the community and state standards for outpatient treatment and the continuum of care.

Additionally, I have a deep commitment to providing quality mental health and substance abuse care whether I am working in the private sector or for a public agency.

When I came on board, Ms. Maculan indicated to me that she wanted to make the outpatient department the hub of the agency and provide quicker, more goal oriented therapy services to the community.

She indicated that she wanted me to do research into what other counties were doing and to develop plans for how we could bring some of the services in house and eliminate as much contracting.

It began as an orderly plan. I not only researched what was going on in other counties, but I studied the current system in place in Walworth County.

I looked at what the Crisis Intervention department did, and what Court Services did and how they interfaced with the outpatient department.

I began making changes in how the departments interacted to provide for more efficiency and speed of initiating services.

As I began reporting back to her on what I was discovering and what I thought we could realistically do, it became obvious that even though she stated that she wanted ideas, she had one model that she was willing to consider, apparently a carryover from her days as the director in Green County.

Despite the fact that her experience there was a decade old, and in a smaller county, she was clinging to that plan.

Many other counties in Wisconsin of similar size are continuing to contract for services.
No other county of similar size has the kind of delivery system Ms. Maculan plans on putting into place.

Contracts have already been cut and those services will not be replicated by the outpatient department.

They are simply gone.

Many of them provided quick responses to crisis situations.

Ms. Maculan envisions a system where clinical social workers doing what four different departments have been doing, in addition to seeing clients.

No other county does that because it isn't efficient or cost-effective.

Before we even had a chance to formulate any of the ideas into a cohesive plan, Ms. Maculan called a meeting in August at which it was decided which positions, whole departments and functions would be eliminated.

No plan was in place for how these functions would be carried out as we cut positions and decided on new ones.

I was horrified because I knew what levels of knowledge and expertise we were cutting out.

I expressed my reservations but was told that this had to be done and we'd figure out the details later.

Details? All I could think of was the people's lives that might be at stake.

Health and Human Services provide for the people in our community who cannot adequately care for themselves and their families due to mental illness, drug or alcohol addiction, being uninsured or underinsured, or poverty.

They typically don't lobby for themselves, or complain when services are no longer available.

So we may not hear from many of them directly, but we can be assured that there will be costly repercussions to this re-structuring.

Walworth County had a team of three superb psychiatrists who were well respected in the community.

They provided people without access to private services quality psychiatric care and medical collaboration with their medical providers.

Mental health treatment relies much more heavily on medication these days, requiring skilled psychiatrists.

All three have resigned and will be gone by the end of the year, leaving 700 people without a psychiatrist.

Finding replacements could cost significantly more than the current doctors were costing.

Ms. Maculan says she gave managers three chances to reduce or keep a zero increase budget.

I was there for all but one week of five months and I was never given one chance.

Every cost saving measure I suggested was ignored or rejected.

My experience was that if I agreed with her, all was well.

If I challenged her on anything, I was told I was wrong.

When Ms. Maculan was holding departmental meetings to tell people whose jobs would be cut, I asked how training would be scheduled so that the clinical social workers in the outpatient department who would be doing Intake, Crisis Intervention and Court Services after the first of the year could learn all of their new responsibilities.

With a hostile look and a disparaging tone she told me that social workers knew all those skills from what they learned in graduate school.

I have a Master's Degree in Social Work and knew that was not the case.

The position of Program Manager of Mental Health and Substance Abuse Services has been split into three different positions, two of which are being offered at a range which ends at $10 per hour more than I was being paid.

Initially, Ms. Maculan stated publicly that I would be able to decide which of the two new positions I wished to stay in.

Without discussing it further with me, she divided the job into three positions and presented the new organizational chart to the Health and Human Services Board with me being given a demotion to Supervisor of Alcohol and Drug Services.

Instead of supervising 12 people and four areas, I would have three people to supervise.

That decision, and the fear of being associated with the chaos which I believed was the only possible outcome for this out of control management style, I resigned, giving four weeks notice.

Ms. Maculan chose to ask me to leave four days after I gave her my letter of resignation.

Ms. Maculan states that no changes that affect clients will go into effect until April.

Initially, the staff were told that all changes would go into effect on January 3.

I can only hope that she is beginning to realize what many staff tried to tell her for the past few months, that what she was suggesting was not possible to do adequately in that short a time frame.

The Health and Human Services Board members, the County Board and Mr. Bretl should be much more involved in holding Ms. Maculan accountable for the numbers she is providing and staff she is losing due to this restructuring.

She is providing numbers to justify past inefficiency that are not accurate.

When challenged on some of those, she simply ignores the new data and continues to use her own figures.

Additionally, she is projecting revenue increases due to her changes that cannot possibly be true.

Mr. Bretl and the County Board are not getting accurate information from her and since staff are literally threatened when they suggest something different, they will not get information from staff without assurances of protection.

To call this resistance to change is to trivialize intelligent, respected staffers who are appalled by the haphazard approach to dismanteling a system that needed some fine tuning, but not gutting.

So much has already been destroyed that turning back to what was is not an option.

As a Walworth County citizen, I am saddened by what has happened in this past year and what will happen.

Short-term cost savings will probably lead to increased budget overages in many areas, including other county departments.

The vast majority of the Health and Human Services staff are dedicated folks who want to work there to provide valuable services to people in need.

The vast majority have been outraged and frightened by the speed of the changes and the refusal to listen to input, frequent public references to the "poor quality" of services that have been provided before her arrival, quoting of incorrect information even after she had been corrected, and general lack of respect for current staff.

Many have tried to reach County Board members, the Health and Human Services Board members, Mr. Bretl, and Human Resources to express their concerns.

It would appear that all those efforts have fallen on largely deaf ears.

Ms. Maculan marches on and more people are asked to leave before their agreed upon departure dates, causing more fear, distrust, and lowering of morale.

The word is out in the professional community about how human service workers are being treated at Walworth County.

The new job descriptions don't match any social worker I have ever met.

I think we will be lucky to get any qualified applicants who are willing to put their reputations on the line doing the variety of tasks that are being required and having the knowledge of the areas which are required.

By the end of December, all Doctors will be gone, the Court Services until will be dismantled with no new program in place, and the daytime Intervention services will be added to the clinical social workers jobs.

All this will be done with no training of the staff who will be taking over these tasks, and the ones who could have trained them have resigned or retired and been asked to leave early.

Nearly 700 people dependent on Walworth County psychiatrists will have no psychiatric care.

Imagine the potential chaos.

Thank you for the opportunity to share my concerns.

Susan B. O'Connell, MSW, LCSW, CADC is the former program manager of Mental Health and AODA Services Walworth County Department of Health and Human Services

Copies of this letter were also forwarded by Ms. O'Connell to the Walworth County Board and the Health and Human Services Board


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