He Lives!

Clinicians say kids mental-health unit haunted by the spirit of Bernard Rappaport

Photo by Johan VogelTwo years ago this Friday, county health officials removed Dr. Bernard Rappaport from his job as head of the county's division of Children and Youth Services (CYS). In the months before his removal (officials called it a "personnel shift"), current and former CYS therapists had told the Weekly that Rappaport had for 22 years run CYS as a dictator. According to the therapists, Rappaport set his staffers against one another, routinely ignored complaints of incompetence directed at his managers, and dodged accountability—a charge the 1992 Orange County grand jury confirmed.

At the time, many staffers hoped Rappaport's dismissal would bring about a calmer, more accountable CYS. They were wrong.

In a 10-page grievance filed with the Orange County Employees Association (OCEA) and the county in August, 72 CYS clinicians say the agency is still a hellish place to work.

Specifically, the clinicians charge that Rappaport's successor, Alan Albright, has unrealistically increased their workloads without consulting them, forcing many to work long overtime hours without pay.

The grievance highlights issues familiar to those who've observed CYS in the past: low productivity, low morale, high stress. According to the grievance, therapists often use sick time to "catch up on paperwork in an environment free of the frequent interruptions inherent to our jobs in a clinical setting."

And of course the phrase "hostile work environment" appears, headlining a section that could've been written at the nadir of the Rappaport era: "Clinicians are frequently faced with legal and ethical dilemmas as they attempt to comply with CYS policies," reads the grievance. "Staff are blamed when poorly designed policies don't work. . . . Feelings of fear and intimidation are common among CYS staff."

Twenty-seven of the 72 clinicians answered the grievance survey's open-ended comment question. All reported variations on the same theme. "How sad," read one, "that in a department titled BEHAVIORAL HEALTH CARE where staff has been trained in mental health and human behavior, so little knowledge of human behavior is employed in its administration and so little care is give [sic] to the health of the employee."

But it was the survey's last question—asking if anyone would participate in a discussion with Albright's office on these issues—that brought the most acidic response. "The present administration has a long-standing and well-known reputation of being vindictive when people complain," the clinician wrote. "Administration retaliates by transferring or asking supervisors to micromanage the employee until he/she quits. Administration seems to be well-liked by upper health-care management. So, NO, I don't want to put myself in front of administration at a meeting."

According to the grievance, in early summer, Albright increased the amount of treatment—called "Standard Treatment Units" (STUs), in CYS shorthand—from 1,000 to 1,200 per clinician. STUs are the way county human resources documents the actual treatment work each clinician carries out each year. Meeting the 1,200 mark will show up in the clinician's personnel file as "Standard"—meaning adequate.

Also according to the grievance, clinicians are required to accomplish 28 daily tasks that don't count toward the STU standard. These include attending staff meetings, listening to voice mail from clients, arranging for sessions at schools, clerical tasks and attending mandatory training.

Therapists also have to deal with an additional increase in their caseload. The clinicians estimated that the new requirements—15 to 18 cases at any given time—require between 37.5 and 45 hours per week. CYS clinicians complain that actual time they spend with clients is counted against them as if it were not work-related.

Neither OCEA, county human resources nor current CYS deputy director Alan Albright's office would comment for this story, saying the grievance constituted a personnel matter. But a July 30 letter from county human resources analyst Lisa Bauer to the clinicians' OCEA representative says the county believes CYS clinicians are meeting the new 1,200 mark.

But the grievance makes it clear that many clinicians—46 of the 72 who filed the grievance—can't meet the 1,200 mark. And those who did often explained their success as a result of working long overtime hours without additional pay.

"CYS clinicians are professionals who will do what it takes to meet expectations," wrote one staffer in a grievance survey conducted by OCEA. "The fact that many are achieving STUs doesn't surprise me because they are most definitely working overtime without pay."

 
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