This has been a big issue for us too...housing is such a problem, and when these guys disappear onto the streets it can be soooo tough to find them and figure out how to keep them stable/safe/etc. We also have quite a few clients who are chronic cancelers/no-show-ers for really important appointments, which can be really frustrating because I'm trying so hard not only to keep them psychiatrically stable but also dealing with dental care, vision, pain specialists, etc.
As it stands now, our team is a full-time (40 hour) therapist, a full time case-manager to deal with housing and vocational concerns, a full-time peer specialist, our psychiatrist who is designated at 5 hours per week for the team, and myself at only 27 hours per week. It's been insane already trying to manage all the clients' medical needs on only 27 hours. They all take their meds wrong, many need shots, most have primary care needs, some have serious pain issues, and now we're looking at picking up our next client who has type 1 diabetes, CHF, and kidney failure. If they can't get this guy in an ALF right away I'm going to freak, lol.
Our team members are great in some ways but I really feel like I'm the only sort of type-A person on the team. At 40 hours per week, the other team members aren't even seeing our ten clients weekly and don't seem very concerned with making sure they get some face time in with them. It's easier for me because I have legitimate reasons to see each of them every week, but I have so much case-management stuff to do in between visits and appointments that I feel like I'm just running at 100 miles an hour all the time and it is frustrating to see co-workers who are just kind of lackadaisical in doing their "thing" with these guys. The peer specialist especially seems to just kind of tag along and be a second on a lot of visits and may chit-chat with them for a few minutes but isn't doing a lot of notes on anyone and in between visits has no case-management so she is looking up trails she wants to hike on, reading books, etc. and it's very frustrating since I really need that time. Since my wage is a lot more than hers they don't have it in the budget for me to be full time (grant-funded at this point) but it just seems so bass-ackwards. I'm not the team lead so I don't have any power to assign extra duties or anything like that, though I am trying to be assertive in saying, look, we all need to be doing regular visits with everyone, even the people we think don't "need" our services. My boss has told me that she feels I'm the team lead in practice, because our therapist is so passive. Which is okay as long as we don't end up with hurt feelings or undue tension. I don't want to be team lead or anything, I just want to be sure we are seeing people to the state's satisfaction and at least TRYING to do therapy and stuff with the clients, even if they are resistant/psychotic/whatever.
I took a HUGE wage cut to take this job and my daycare expenses quadrupled. I was working relief night shift at the psych stabilization center and only had a few days of day care a month as I'd mostly pick up shifts when my husband would be off. But I'm just starting grad school and I wanted the experience of working in community psych because I feel there will be a strong need for it and I'd love to be able to keep in that vein or go back to it in the future someday if possible. I also wanted to be the first ACT nurse in the area since it is a brand-new team. It's basically my dream job, aside from feeling a lack of structure. Oh, one thing that is hugely aggravating is that being brand new, like I said, we are really on a shoestring budget. Although there are four people on our team and we can only see people in pairs, we have only one car. This leads to soooo much stress when it comes to staffing appointments and doing visits. We also have these really old, ghetto 2001-type cell phones when what we really need is smartphones where we can schedule out in the field and have GPS and data. We are just using our own phones for these purposes, but they are a NEED. Additionally, and this REALLY sucks, we are actually going to lose our office space in a big remodel coming up and everyone who is community-based (several teams and in total about 20 people) are going to share a big lounge-type room that will be more like a college computer lab. Our own personal desks with all our files, supplies, references, documents, etc. will be gone and we will just all be sharing lockers and workspace. So I feel like things are going to actually get worse rather than better when it comes to having adequate resources for doing our job.
Thanks so much for the response! I hope you get the job. I love it, I have not felt threatened or unsafe as of yet and I'm hoping I don't get attacked anytime soon. Our caseload is going to quadruple in the next few months, though, and things are going to get really crazy then. They let us start out with a very small group of clients until we got to where we had documentation/care plan issues ironed out and got a feel for what our roles would be. We still don't have any referral or admission process, which is desperately-needed, but I'm hoping that will fall together soon. I think it's really cool to be part of the ground-floor of a new program in this area (rural Colorado).