Saturday, January 17, 2009

The Baristas

Me and my extended metaphors.

Suddenly I find myself riffing on how if I'm going to use the name "House Blend" for the relationship-based therapy served up by Agency 2, the staff must be the baristas. Right? It's actually not such a bad analogy. They're the ones actually assembling and serving it up on a day to day basis. For the benefit of our (lone) male line therapist, I also hasten to point out that the World Barista Champion of 2008 is a dude -- the feminine-sounding ending on the word does not imply an all-female staff, though in our case it's pretty darn close.

Here's how Joy's team is structured.

At the head of the team is the Lead Therapist, a professional (degreed) clinician who is responsible for Joy's treatment plan. We were fortunate that she was also the therapist with whom we did the out-of-pocket work while we were waiting for Joy to pop to the top of the waiting list. She also keeps tabs on Joy through this blog and the Yahoo! Group that Lynda and the school-district therapists and I use to exchange reports. She supervises the Senior Therapist and attends team meetings every other month (I think) and also periodically does a session directly with Joy.

Next in the chain is the Senior Therapist. She supervises and helps train the Line Therapists, runs the twice-monthly team meetings, and does a session with Joy just about every week. I believe the required degree for this position is a bachelor's degree, though in a university town people's qualifications often exceed the minimum (like the taxi drivers with PhD's kind of thing). Lots of training & experience go into this one too!

Then the baristas who are behind the counter each and every day -- the Line Therapists. We have five of them. The required qualification is a high school diploma, though I believe all of our line therapists exceed that (we even have a speech-therapist-in-training who is most of the way through her graduate work!) Then there's some training at the Agency 2 office, and then 30 hours of supervised hands-on training, and then the line therapist can go solo.

The standard House Blend session is two hours long, with the final 15 minutes devoted to report-writing. Our fully-staffed weekly schedule involves 12 sessions with Line Therapists, or 24 hours a week, not counting any additional visits from Senior or Lead Therapist. Two sessions per week are at daycare, the rest are at home. Then twice a month we have a one-hour team meeting. For all of these hours, there must be a parent or suitable stand-in adult caregiver present.

When you figure that we also have four one-hour visits from school-district therapists (one occupational therapy, one speech therapy, two special-educator, who also sits in on Agency 2 team meetings from time to time)... Our schedule is just nuts. And Joy's getting bombarded with one-on-one attention.

We have an excellent team going right now. Hiring has been an issue, and it took longer than the state likes to see to get the team up to full strength -- technically we are responsible to get in 80 hours per month, and that didn't happen until December, though the team started assembling in July. We had lots of early washouts, including a couple of hires who never even darkened our door, one who had overbooked herself and bowed out while in training, another who left for a job more squarely in her field after having completed training.

I enjoy getting acquainted with our team members. Despite the official warnings in the paperwork about professional boundaries, I find that we share nuggets of our lives in conversation just because we do spend so much time together. So we've got the therapist who actually has worked as a Starbucks barista, and the one who has handbells in common with me and rock-band experience in common with JoyDad, and the one who used to sell jewelry in the parking lot at Grateful Dead shows, and the one who's working on a double-major in mathematics and art... It's really a delightful group. I hate the thought of the inevitable graduations and other turnover, but I guess that's part of the way things go.

Examples of Joy's goals, and the contours of a typical session, I'll save for future posts.

A final word about terminology, though. My career, such as it is, is in the field of librarianship. I have the master's degree and, as such, am qualified to work as a librarian. It makes degreed librarians all kinds of cranky when people refer to the high-schooler behind the check-out desk as a "librarian." It strikes me that there is something of the same dynamic with the word "therapist." Professionals who have worked long and hard for the various therapy degrees and credentials tend, I think, to shudder when the term "therapist" is applied to folks like Agency 2 line therapists. But... that's the terminology that Agency 2 uses, so that's how I'm going to phrase it. No disrespect to higher levels of credentialing is meant thereby. Meanwhile, the line therapists are the ones on the front lines serving up the House Blend, and we very much appreciate all that they are doing for Joy, and in relationship with Joy.


Anonymous said...

I'm one of the students who work behind the check-out desk at the library. I'm always amused at the terribly confused faces of patrons when I can't answer one of their questions and offer to "get the librarian."

Anonymous said...

Well, call 'em what you like, JM, but that do not make it so.

Kind of you to acknowledge ahead of time my consternation about calling them therapists. Tells me you do pay attention to what I post. ;)

While reading, I was just going to ask what kind of therapist they are. So long as they do not attach the magic words occupational or physical before the t-word, they can use the word generically.

My request in future House Blend posts would be a description of what happens during a session. My pre-formed opinion is that it will look more like teaching than therapy.

Can Lead Therapist (degreed professional) call herself a psychologist, or counselor? Professional what? I don't think Behavioral Therapist has a legal premise. That is, a license.

Licenses, issued by the state, are the reason they cannot use the O or P designations. (OTs are not licensed in every state but have ownership over the title via certification.)

Seems reasonable to me that if they call themselves therapists - a job title assigned by their business - you should use that terminology, too, while sharing about Joy's service providers. No shuddering here. I just think it's fair to distinguish the titles for everyone's benefit.

My opinion, beneficial or not - you decide - is that using the term therapist without a legal premise is a marketing method. I acknowledge it makes little difference if it helps Joy.
Barbara aka BRatK

JoyMama said...

Cale - that's how this librarian started out, with a work-study job during college at the circulation desk!

Barbara - I do plan to describe a session, but I wonder if I will catch the details that might distinguish teaching from therapy. With Joy's staff from Birth to Three and the school district, the lines surely blur between what the OT, ST, and Special Educators did and do.

Regarding our lead therapist, since I have not discussed this series of posts with her (guess we'll have that conversation after she reads them!), I'm being a little cagey about the lines between the job description and the individual, such that my local readers who know Agency 2 won't necessarily identify who I'm discussing here. Perhaps this will help: there are 4 lead therapists at Agency 2. Three of them have PhD's in various flavors of psychology (e.g. developmental psych, rehabilitation psych) and one has a master's in marriage and family counseling and the Licensed Marriage and Family Therapist credential. My description was supposed to catch them all.

I am reminded of the quote from Through the Looking Glass -- "'When I use a word,' Humpty Dumpty said, in a rather scornful tone, 'it means just what I choose it to mean, neither more nor less.'" Makes it hard to reach common understandings!

Anonymous said...

Forgot, er, I was thinking this last time, but did not include...perhaps taking the discussion to other places....

Cale, I have been one of those confused faces before. Now that I know, I think that is as it should be. And you all should wear name tags with your job titles in big-enough letters for us older folk to read. chkl.

Also forgot to mention, therapists teach, too.


That really clarifies roles, eh?

Is behavioral 'therapy' educational or medical? A right or healthcare? All of these things? WHO will decide?

You will. For yourself and your children.

I interact off-blog occasionally with someone whose blog is star-status compared to mine. (I so like getting the attention of the famous! Sin of pride just confessed.)

Last week she was posting about her problems with the school district that they specifically moved-to for their children making boundary changes that upset more than a few people.

Here is a sentence from my message to her: "I give you a pat-on-the-back for choosing your home with the schools in mind and for believing in the public schools. At some point, just saying, you might have to choose between what you believe is best for your children and what you want to believe is best for all children. Might. Hope not." To which she replied: "Yeah. I know.

If you are searching for simplicity in what to choose for your child, the simplicity I encourage is taking ownership of your decisions and not expecting anyone else to solve the dilemma for you.

Requires some self-confidence as a parent. Not easy. Truly what I believe. Barbara/BRatK

pixiemama said...

Just going to jump in and say that 'round here, they are called TSSs, short for Therapeutic Support Staff - and I love that. It is perfect. Not a therapist. Just support staff. Foster has his own staff.

And Joy Mama? I hope you're getting some sleep? I find it exhausting to "host" all of those people in my own home, at least until everyone gets used to one another (and until they get used to the smell of my noxious brew of coffee).