Candidates discuss mental disabilities, staffing issues

Saturday, July 23, 2016

Continuing education, training remains a priority

The Barry County Public Administrator elected on Aug. 2 will have more than 150 clients to maintain, and some of those clients require more attention than others.

Many of those under the care of the public administrator suffer from mental or physical disabilities, and whoever is elected must be able to deal with possible behavioral issues that may stem from mental illnesses.

Candidates vying for the position include Andy Reavis, R-Cassville, the chief operating officer with Billings Mutual Insurance Company; Rodney Hughes, R-Cassville, a customer care specialist at Fasco Industries; and Keith Daniels, R-Exeter, a retired healthcare finance executive.

Hughes said all clients deserve the utmost respect when dealing with problems or issues.

"The public administrator's office deals with many client issues, one of which might be mental or behavioral disabilities," Hughes said. "All people, regardless of the reason they are assigned by the court to the public administrator's office, are due the same respect and help as any other person."

Daniels said building good relationships and maintaining clear communication is paramount to the position.

Daniels

"The key to dealing with people suffering with a mental disability is to establish a relationship that is built on trust and mutual respect," Daniels said. "Establishing [that] relationship is dependent on good communication skills.

"When speaking with any client, whether they are mentally ill or not, it is so important to be a good listener. People many times just want to be heard and to voice their grievances without being interrupted. It is also very important to speak with these clients in a respectful and compassionate manner. You must let them know that you are their advocate and that you above all want to do what you can to help them. Above all, let them know that you value them as a person and that you are their friend."

Daniels said one of the most common behavioral issues is poor anger management.

"When meeting with a client who is angry, it is imperative to defuse that anger and to keep the incident from escalating and turning into a confrontational meeting," he said. "You must be able to control your own anger, as well, when speaking a client who may be exhibiting this kind of behavior. There may be times when that client will become insulting and attack your integrity and professionalism. There is nothing to be gained by getting into an argument when meeting with a client."

Reavis delved deeper into the complexities of mental disorders.

Reavis

"The term 'mental disabilities' perhaps could be better substituted with mentally incapacitated," he said. "Incapacitated, meaning the client may suffer from a wide range of mental illnesses including, but not limited to, anxiety disorders, bipolar disorder, depression or schizophrenia. These examples of disorders affect a person's thinking, feelings and their ability to relate to others which by definition is a mental illness. No doubt, a significant percentage of the clients assigned to the Barry County Public Administrator suffer from mental illness."

Reavis continued to outline his thought on the ongoing challenges facing the public administrator's office.

"Understanding and working with the changing clientele is, in my opinion, the biggest challenge. Older residents of nursing homes are no longer the exclusive client of the administrator. A significant percentage of client cases now involve dealing with a range of mental illnesses some of which result in behavioral issues. In that respect, each client represents a unique person and set of circumstances. Working with a range of challenging issues requires the personal experience of the administrator, seeking advice for similar issues from other experienced individuals, and as much education as possible dealing with issues like mental illness. There are also facilities that exist statewide which are staffed and equipped to work with behavioral-issue clients if needed."

Daniels said he is the only candidate with previous experience in dealing with individuals exhibiting behavioral or anger issues.

"One of my primary duties when working for Mercy Health was to meet with patients who were unhappy about their hospital bills and wanted their questions answered," he said. "There were many times when that person was angry and sometimes even irrational. It was my responsibility to listen to the patient, fully document their concerns and to do everything I could to maintain a good relationship with the patient. Mercy Health has long recognized the issue of dealing with patients who have mental or behavioral problems. It is not uncommon for healthcare providers and staff to be physically attacked by angry patients who have experienced a mental breakdown.

"Most hospitals now have a security department which is given the responsibility of subduing any patient who is out of control. In my 25-year healthcare career, I have been in many meetings with patients where the potential of an escalation in anger has been present. I am very happy to say that I have always been able to defuse those situations and to keep the meeting as respectful and productive as possible."

All three candidates expressed an interest in receiving additional education and training in handling clients unable to make informed decisions concerning their self-care.

"I would be willing to take a class or receive as much relevant training as possible," Daniels said. "It is very important that [the public administrator] is committed to educating themselves on all of the issues they will have to deal with. One of the more pressing concerns is how to monitor and counsel clients who are mentally ill and are taking medications to help control or alleviate their particular medical conditions.

"I've done some research on receiving ongoing training and education that will [in working with] patients who may have mental or possible addiction problems. I've learned through making phone calls and looking at The Missouri Association of Public Administrators website that there are continuing education opportunities which I think will help any public administrator do their job in a more professional manner. MAPA has annual meetings which are normally four or five days long, which provides specialized training for public administrators. I've also been able to talk to other public administrators about continuing education and learned there will be a Family Guardianship conference in Kansas City on Aug. 16, which I think will be an excellent opportunity to learn more. If elected, I will definitely attend that conference and will always make continuing education a top priority for both myself and the current staff member."

Hughes

Hughes agreed continuing education in the role of public administrator is important.

"Any time a class or training is offered that can present new or helpful information on any clientele, the PA should be in that training and learning," Hughes said. "If elected, there will be areas that all of us will feel more knowledgeable in than others. Training is a very important part of making ourself the most knowledgeable and informed that we can be as we deal with each issue that each client brings to this office. If elected my goal will be to meet the needs of each client regardless of the reason they have been court appointed."

Reavis said he plans to seek opportunities for further education in the role of public administrator.

"One of my first-year goals as administrator would be to actively seek out educational or training opportunities," Reavis said. "The education, training and experience of the public administrator are crucial to advising those needing to make tough life choices including their self-care decisions. One lesson learned from being in business is when people are faced with tough decisions and asking your opinion, they want and deserve a straight forward answer. Education, training and experience are a big part of being able to provide that answer.

"I have not explored the public administrator educational or training opportunities but suspect a lot of self-education is required and time outside of regular business hours. This will require an extra level of commitment from the incoming administrator. I want voters to know I can handle this position. Given the opportunity, I will commit to not only being adequately able to perform the job but to excel as a professional."

Hughes said service to clients is the priority of the public administrator, and staffing needs would be continuously assessed based on the client census.

"The public administrator [responsibilities include] serving the clients of the county who fully rely on the help and service of the elected [individual] and staff," he said. "If at any time the client is not served in a timely and respected manner, the reason needs to be assessed. If the reason is because there is only one staff person, then that need should certainly be addressed.

"Everything within the office should be working efficiently for the needs of those it serves. If the voters of Barry County elect me to the position of public administrator, I will continuously evaluate how to best serve the clients and the community."

Reavis said staffing needs should be driven by the administrator's caseload.

"The Barry County Public Administrator currently serves 158 clients," he said. "That number exceeds many of the surrounding counties and, in some cases, exceeds the number of clients in those counties combined. Barry County clients are served utilizing one public administrator and one staff person. In comparison, Greene County serves approximately 500 clients, utilizing one administrator, five deputy administrators and four additional employees.

"Judging from those comparisons, the workload for the Barry County administrator has been tremendous. Both Barb White and Pam Modlin have done amazing jobs in performing their duties as public administrators using limited resources. The current number of clients may represent a maximum workload for one administrator and one staff person. If that number continues to grow, I'm sure, at some point, [the caseload would] justify another staff person. Until that point is reached, the office will continue using current staff levels."

Reavis noted there are concerns, other than staffing, to consider.

"Hiring more staff entails adding expenses to an already tight county budget as well as the physical issue of needing more office space," he said. "Expenses are definitely one area any administrator has to be aware of and deal with. While the need for more staff may exist now, everything considered, adding personnel probably cannot be justified at this time."

Daniels believes additional help is required.

"After meeting with Pam Modlin, the current public administrator, it is my opinion another staff member should be hired," Daniels said. "The additional staff member would be paid from the public administrator's existing fees and would not require any additional taxes or fees from clients."

Daniels called other county public administrator's offices and inquired into the number of clients being served compared to the number of staff members working the caseload.

"Lawrence County has around 100 clients and McDonald County has between 80 and 100 clients," he said. "Both of these offices currently have one staff member in addition to the public administrator. Newton County has around 250 clients and has four full time staff members, budgeted to work 37.5 hours a week, in addition to the public administrator. Other counties made it very clear they are extremely busy and working as hard as they can to keep up with the current workload. Nearly every decision and action a public administrator makes on behalf of a client requires some sort of documentation. The office maintains files for each client, which contains documentation on everything from medical conditions to reconciliation of bank accounts. It is almost a never ending job for the staff.

"In comparing the caseloads for each office, Barry County clearly has a much heavier workload. Additional staff would be hired only after I've had enough time in office to do a thorough analysis of policies, procedures and current workflows."

The individual elected to fill the role of county public administrator will be responsible for a number of day-to-day duties, including administrative, clerical and reception. County public administrators must be on call 24 hours a day, seven days a week, to respond to any issues that may arise with a client. The official is also responsible for keeping in contact with hospitals, health-care facilities, hospices, law offices and other agencies on behalf of clients.

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