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Week 1 Journal

This week Ive had two meetings with my immediate supervisor, Linda, who is the
Associate VP of the Adult Behavioral Health and Substance Use at Center For Family
Services and her co-worker Ann Marie, who heads the counseling aspect of the drug
rehabilitation program. They both have a wide range of experience and have mentored
interns at the agency before. They are very supportive of my internship and have
expressed enthusiasm in guiding and encouraging me in processing the information
necessary to be successful as an intern there and taking the skills learned to further
my ambitions.
One major goal the agency has this year is updating their policy and procedure manual
based on the NJ State standards for outpatient treatment facilities. Theyve asked
me if Id like to get the ball rolling on this task and I said yes. This project will
involve a review of the current procedures manual by reading each policy and then
grouping like policies together giving headings for each group. Once the headings have
been identified Ill need to make a table of contents. Once this aspect is done, Im to
compare the current policies already in place with what the State standards are and
then identify which policies to keep and which new ones need to be created.
The ultimate goal is to have a policy and procedures manual that is organized and in a
logical sequence that any employee can pick up and know where to find specific policies
should they be asked by a state inspector or grant funder when they visit.
One of my greatest strengths is my commitment to whatever the task is. I see it
through even if its not something Im particularly interested in. I try to see
everything as a learning experience, i.e. what to do, what not to do and how to do it
better if there is a next time. The project of the policy and procedures manual for
the agency has me a tad bit overwhelmed, but Im efficient confident I can do it. So
long as Linda and/or Ann Marie make themselves available to answer my questions and
offer their input, Ill do a great job.
One immediate self-improvement purpose in putting together the policy and
procedures manual will allow me to learn something new and gain self-knowledge. It
gives me a chance to develop and improve my writing skills and will also give me a
chance to make meaning out of what Im reading.
Week 2 Journal Entry
This week I did a lot of reading. One of my tasks is to revamp the policies and
procedures manual. In order to do that I have to become familiar with the State of

NJ guidelines and then become familiar with the policies and procedures the agency
has developed for their drug abuse program. I started out reading a little of both but
soon started to confuse the two. I told Dr. Bescherer the trouble I was having and
she suggested I do one at a time. I decided to tackle the State guidelines as they are
pretty easy to understand and they also set the basis for how the program is to
function. I also met two more of the staff (counselors) and they seemed friendly and
eager to answer any questions I had. Dr. Mur was in the Williamstown office in a
meeting with the staff there and didnt come back to Voorhees until 3pm. She gave
me a list of Linkages and the agencies commitment letter or contract and asked me to
follow up with them on Monday. Linkages are other non-profits whose clients may
need the resources of Center For Family Services. These commitment letters not
only need to be updated, but the signed commitments must also go into the policy and
procedure manual.
Week 3 Journal Entry
Yesterday, Friday, 1/30/14, Dr. Mur held a mandatory staff meeting with the
supervisors, counselors, interns and billing clerks for the three substance abuse sites
consisting of the Williamstown, NJ site, the Camden, NJ site and the Voorhees, NJ
site. The topic(s) included citations from the recent audit inspection and the
A.W.A.R.D.S software program that is used for intakes and progress of the client.
The morning session was devoted to seven citations that the auditor found in random
files pulled that were missing one or more reports, i.e. DAS funded slots not filled at
95% capacity; a requirement of 4 contacts of individual counseling during the month of
October. The DAS funded slots are the agencies first obligation as without this state
funding, the program would soon fold. Dr. Mur, in her examination of the files
discovered two things.
One, the counselors were waiting too long to discharge a client when they are MIA for
counseling and two, the State of NJ who dispenses vouchers for the DAS program
suspends the voucher when it hasnt been used in 30 days. Dr. Mur explained that
when the State suspends the voucher it appears the agency has no clients and
therefore no need for funding or the counselor is not doing their due diligence to get
the client to show up for appointments. I suggested that the burden shouldnt fall on
the counselor alone; that the clients probation officer or DYFS case worker should
work as a team in getting the client to show up for their appointment. Dr. Mur
thought that was a great idea and added that the counselor should also stress that
when the client fails to show up within a two week period, their voucher will be

rescinded and they will have to come out of pocket for future visits because the
funding may not be there when they return.
The afternoon session was a tutorial for the A.W.A.R.D.S software program. This
program is used agency wide as it contains the intake, assessments, counseling
sessions, toxicology reports and general notes by the clinician. Some of the clinicians
were not filling the forms out completely and/or were doing redundant work. The
tutorial gave everyone a chance to express their frustrations with the program and
was given better ways to make their work load a little easier. Dr. Mur thanked me for
my questions and suggestions. I learned a lot and had a very good day!!
Journal Entry #4
This week I spent reading and becoming more familiar with the State policies for the
manual I am updating for Center for Family Services. I learned a lot more about the
agency and the many support services they provide to the different counties. There
are so many issues plaguing our communities that I was not aware of. I found myself
saying "thank you" to the services I read about simply because I didnt know there was
a need for it. The more I read, the more anxious I felt because I want to do a good
job. I had to remind myself that I've got time and Dr. Mur and Dr. Besherer are
always there or a phone call away to guide me. I worked myself into a headache
before lunch but was able to get rid of it by 3. Two weeks ago Dr. Mur gave me a list
of linkages and the agencies commitment letter or contract and asked me to follow up
with them on Monday. Linkages are other non-profits whose clients may need the
resources of Center for Family Services. I put together a rough draft of the
letter/contract, however Dr. Mur hasnt given me feedback yet.
Journal Entry #5
This was a very stressful week for me. I hurt my back on Sunday and missed 3 days
of work on my job, my internship and school lessons. I talked to Dr. Mur who had
something planned for me; although I dont know what it was, I could tell in her voice
that she was disappointed that I wouldnt be showing up this week. She did tell me
that Fridays were no longer good for her as she has to attend to other field offices
and Fridays work best for her to do that. She also told me that Dr. Bersherer has an
opportunity to do private practice on Fridays and would not be there as well. I asked
her to pick other days that will work for them and she said she would get back to me
by Monday (2/16). Now, whatever day they choose, I have to inform my boss at my
regular job that I'll be switching days. I was able to read more of the States' policy

and procedure manual but that was about it. I hate being unproductive and cant wait
to feel better so I can get back in the game.
Journal Entry #6
My experience thus far in the human services field has been challenging. Most of my
experience has been working with individuals or groups in my church but not much at
all with families. Ive fostered teenage girls who have children and they think because
they are mothers they are my equal. In my world, youre an adult when you are
independent and self-sufficient. I had to learn that these young girls come from
backgrounds very different from mine. Their boundaries are non-existent. I learned
to be calm and not feel threatened or disrespected when cursed at or rules were
broken. My internship deals with adult substance abusers and the majority of them or
forced to come to treatment. I have yet to be able to sit in on a meeting so I dont
know how I would expand. Change takes time.
Journal Entry #7
We finally had the policy manual inspection and it went really well, considering the
outline for the inspection changed 48 hours prior to the site visit. We did the best
we could under the circumstances. The inspectors name was "Alfreda" and she did the
inspection for CFS five years ago. As she went through the manual, those policies she
couldnt find or needed more clarification, she asked me where they were and I was
able to get them thereby abating a citation. I wasnt able to clarify a few of them on
the spot, but she allowed the agency to provide it to her over the next two days. She
went to the Glassboro facility on Monday and the Camden facility on Tuesday to look
at personnel records.
The experience was stressful as Dr. Mur was caught off guard about the visit. I had
had the manual in my possession since the beginning of January and was told the
inspection probably wouldnt happen until closer to May. My instructions were to
become familiar with the State procedures and apply them to the manual rewriting or
updating the policy as it applied to the service. I had done a lot of work on it but was
not as prepared as I would have liked had I been given more time. I was tempted to
ask Dr. Mur why she didnt ask for an extension so she could better prepare, but I
didnt because I didnt hear her or her assistant mention that in any of our
conversations. I'm glad I went with the flow because I would have been seen as a
slacker. All in all it worked out.
This past Wednesday, I was invited to an Advisory meeting which consisted of Dr. Mur
and her heads of staff. This advisory meeting is held every first Wednesday of each

month. We waited for an hour and key people didnt show up. Dr. Mur said this has
been happening since its inception. It seems budget cuts have slashed their staff and
more than one of them in the Glassboro office has been serving as receptionist as well
as counselor to their clients. She hasnt been able to get them to participate on a
regular basis because the help that was found for them decided not to participate
because of the red tape. Seems volunteers are run through the mill as is regular paid
staff. Dr. Mur's hands are tied and she thinks that the budget cuts are a prelude to
closing either the Glassboro or Williamstown office.
Journal Entry #9
This week I worked with human resources in trying to find a psychiatrist for the
substance abuse clients in the Glassboro and Williamstown NJ locations. Dr. Mur
explained to me that "drug court" has a problem with agencies like CFS because they
are not servicing people the way they think they should be, in that some of the clients
need more than group counseling. Dr. Mur said a lot of drug abusers have underlying
issues that need to be addressed and abusing drugs helps them cope with those issues.
She said she somewhat agrees with drug court, however, it is very hard to get a board
certified psychiatrist to want to work with state agencies because of the pay rate.
She gave me a few websites to look on and one or two employment agencies to call. I
made 20 calls on Thursday and spoke to two receptionists; the rest went to voice mail.
There were a few I didnt bother to leave a message because they either said in the
voicemail that they only accept cash or didnt deal with Medicaid. I did receive two
return calls from Tyreasea Johnson and Steven Neff. They both told me they work
for private agencies and would not mind freelancing on the side. I told them who I
was and that their services were needed Monday through Friday and they had to
accept Medicaid whose board rate is $157 an hour. They both said they'd be willing
to explore this further with Dr. Mur, so now I have to set up interviews.
Journal Entry #10
Last Wednesday during my internship I was given the task of calling the counselors in
the Glassboro and Williamstown offices to collect their monthly reports which Dr.
Mur submits to Trenton. Before I made the calls, Dr. Mur who is my internship
supervisor, explained to me what the reports should contain. The very first call I
made was to a counselor named Lori and unbeknownst to me has a chip on her shoulder;
lately, because she was passed over for a promotion. Apparently, Dr. Mur sent out a
memo to several counselors some time ago, detailing the necessity and deadline for
certification in order to be promoted. Long story short, Lori did not comply, a job
opened up and her colleague with less experience, although very capable, received the
promotion. When I called Lori to discuss with her that her monthly report was

missing some information, she was immediately indignant. Telling me in a very


condescending tone that Im just an intern and that I didnt know what I was talking
about. It took every ounce of me not to go there, but I took a deep breath and told
her I may have misspoke and that I will go over the docs again and will call her back.
When I hung up the phone I went to Dr. Mur and told her what happened and asked
her to sit in on my next call to Lori.
When I called her back, I told her she was on speaker because Dr. Mur was in the
room to guide me through. I repeated the same exact thing I said to her earlier
however, her response was entirely different. She was helpful, thoughtful AND
respectful. She also owned her mistake on the report and promised to fix it and send
it back to me in a timely manner. Loris behavior towards me is classic of what our
textbook speaks of regarding organizational culture. I met Lori at the staff meeting
I attended last month. Dr. Mur introduced me and everyone in the room was cordial
and welcoming except Lori and James. James coolness was justified because he was
preoccupied with trying to hold onto his job. Lori however, treats everyone on the job
with disdain who she feels does not have her experience or job longevity. She places a
high value on individual effort and autonomy (Kiser, 2012, pg. 215). Her behavior is
tolerated but not valued by the rest of her team. Dr. Mur confided in me that Lori
wouldnt have gotten the job anyway. Shes been with CFS for more than 20 years
starting out as a van driver and working her way up. Unfortunately, along the way she
developed her own style of doing things and is not a team player. She hasnt gotten a
raise in almost 4 years because of budget cuts but hasnt been terminated because
they need her and she knows it.
Journal Entry #11
On Wednesday, March 25th I was invited to a finance meeting that consisted of Dr.
Mur, the program director, and her administrative staff from the Voorhees,
Glassboro and Williamstown offices. The CEO of Center for Family Services, Mr.
Stagliano had called this meeting because of complaints/concerns from the
administrators of not being fully connected to the new billing program thats been
implemented throughout the program. Medicaid and Medicare have asked that CFS
along with thousands of other programs start using this new system to simplify the
billing practices. Apparently, the codes used for payment will speed up the process
for payments and everyone who relies on Medicaid and Medicare for reimbursement
must get on board in order for claims to be processed. The problem is that no one
knows how to use the new system.

Its been a year since Medicaids request and of course, payments are not being
received in a timely manner and some overbilling has occurred. An administrator
named Colleen had hired an outside firm to come in and show her and her team how to
use the system but when Mr. Stagliano found out about it, he shut it down, said it was
a waste of money. In Wednesdays meeting he heard the complaints of being left in
the dark with this new system and made the decision to ask Colleen to learn it and
teach everyone else!! The room went quite. They were probably in shock as I was.
She slowly nodded her head yes and Mr. Stagliano left the room. Not one person
spoke up and said how cost effective it was for a contractor to teach them how to use
the system because they knew what they were doing and could answer any questions
that came up during the training. I could go on and on about what I find wrong with
Mr. Staglianos leadership from this one encounter, however, in summation I bet that
the $5k he saved CFS will go toward his bonus this year.
Journal Entry # 12
This week Dr. Mur received a follow-up letter from the Office of Program Integrity
and Accountability in reference to the biennial programmatic survey conducted on
March 3, 2015. The Office of Licensing found the facility not in full compliance with
the Standard for Licensure of Outpatient Substance Abuse Treatment Facilities and
has asked that the Voorhees office submit a plan of correction. The list of items to
be corrected is (1) documentation of staff orientation/education in each personnel file
(there was no such documentation in personnel records of employees #1 and #5;
(2)the policy and procedure manual was not signed/dated by the administrator and
governing authority presiding officer; (3)the personnel record of employee #5 did not
contain documentation of Monteux testing or a physical examination and lastly, (4) the
treatment plans of clients #1 and #3 did not contain time frames for the clients to
achieve their goals.
Dr. Mur asked me to handle the deficiencies and gave me a deadline of next Tuesday.
The first thing I did was call the author of the letter, Gloria Santos, who is the
Quality Assurance Coordinator in the Office of Licensing, Addiction Services. She
gave me specific information such as who employees #1 and #5 are and who clients #1
and #3 are. She also said I need to reference the specific codes when abating each
deficiency that are found in the Standards for Licensure of Outpatient Substance
Abuse Treatment Facilities in order for the Voorhees facility to receive a passing
grade. My intent is to find the codes in the Standards manual and reference it for
each deficiency and then describe with specificity what corrective action will be taken
to correct it.

Ive abated 1) to read:


According to NJAC Title 10:161B-3.5(a),(f)1 The facility shall maintain personnel
records for each employee, including, but not limited to, . . . documentation of staff
orientation and staff education received, . . . emergency plans and procedures,
infection prevention and control program, universal precautions and
policies/procedures concerning conflicts of interest, ethics, etc. All new hires
receive orientation that includes the general requirements outlined in the Licensure
Standards. Documentation of such was kept in a separate file in the facility where
they work. As of April 10, 2015, copies of this documentation were given to the
Human Resources Director to be kept in all employee personnel files which will be done
going forward. To prevent this deficiency from occurring again, the Human Services
Director will send reminders to the staff every other year to submit verification of
current licenses/certifications and physical exams indicating current booster records.
I will write the other three corrections and present to Dr. Mur on Monday for her
thoughts and assessments.
Journal Entry # 13
Last week Dr. Mur received a follow-up letter from the Office of Program Integrity
and Accountability in reference to the biennial programmatic survey conducted on
March 3, 2015. The Office of Licensing found the facility not in full compliance with
the Standard for Licensure of Outpatient Substance Abuse Treatment Facilities and
has asked that the Voorhees office submit a plan of correction. I was given a list of
four items to be corrected and completed the first one last week. This week I
attempted to correct the other three which I have included below.
Ive abated 2-4 to read:
2) 10:161B-3.7 Employee health (a) The policy and procedure manual shall include
policies and procedures to ensure that physical examinations of staff are performed
upon initial employment and at subsequent intervals. Policies and procedures shall
specify the circumstances under which other persons providing direct client care
services shall receive a physical examination. Policies and procedures shall specify the
content and the frequency of the examination. (d)6. The Mantoux skin test shall be
repeated on an annual basis for all employees unless contraindicated.
All new hires are required receive and produce documentation of a physical
examination including current vaccinations outlined in the Licensure Standards. As of
April 10, 2015, copies of all employee physical records will be kept in their personnel
file with the Human Resources Director. To prevent this deficiency from reoccurring,

the Human Services Director will send reminders to the staff every other year to
submit verification of current licenses/certifications and physical exams indicating
current vaccinations.
3) 10:161B-3.7 (d) 6 Employee health The Mantoux skin test shall be repeated on an
annual basis for all employees unless contraindicated.
All new hires are required receive and produce documentation of a physical
examination including current vaccinations outlined in the Licensure Standards. As of
April 10, 2015, copies of all employee physical records will be kept in their personnel
file with the Human Resources Director. To prevent this deficiency from reoccurring,
the Human Services Director will send reminders to the staff every other year to
submit verification of physical examinations indicating current vaccinations.
4) 10:161B-9.2 Client treatment planning (a) A client treatment plan shall be developed
for every client based on the assessment of the client in accordance with N.J.A.C.
10:161B-9.1. ix. Long and short term goals with timeframes for achievement.
The Center for Family Services Substance Abuse Treatment Plan has been amended
to include a plan of action for short term goals with a time frame of 30 days or less
and long term goals to be met in the time frame of 30 - 90 days. This amended
Treatment Plan will be available for all new clients as of April 10, 2015.
Dr. Mur had some fires to put out this week and said she would go over these with me
next week when we meet.
Journal Entry # 14
This week Dr. Mur gave me her thoughts on what I did last week to abate the list of
items the Office of Licensing found were not in compliance when an inspection was
done of the policy and procedure manual on March 3, 2015. She said she asked for a
couple of more days to submit corrections to the State as the inspector was out of
the office and so was Dr. Mur.
What I have done has gotten us closer to what Dr. Mur is looking for and she liked the
long and short term goals. However, she wants the objectives and the term
substituted for Interventions. She sent me samples to look at from other facilities
and said I dont need both. Although, it seems to me that objectives is the preferred
term. She wants me to take out the references to counselor and client altogether or
put counselor or client rather than one or the other.

She also suggested I work in the six dimensions into the problem statements whereby
each dimension has its own area to be addressed with problem, goals and objectives.
This way the objectives may address more than one problem area at a time and
therefore as long as the dimensions are addressed at the outset in the problem area,
the goals and objectives can cover more than one problem.
Journal Entry #15
Dr. Mur critiqued my Plan of Correction and Treatment Plan today. She advised me to
use more of the language in the letter of deficiencies given to the agency by the
Office of Program Integrity and Accountability. I rewrote them as soon as I got back
to my office and forwarded same to her. Were meeting again next Tuesday, April 28
so I can get my letters of recommendation from her and Dr. Besherer. Before I left
today I gave each of them a thank you card and a gift bag with Dunkin Donuts kcups
inside. Dr. Mur walked me to my car and told me shes going to request an intern every
year from now on. She said my service was invaluable to her and that I made her life
much easier.