State plan would replace mental-health caseworkers with private case managers

~ The caseworkers serve people with disabilities such as cerebral palsy, head injuries, autism and epilepsy.

ST. LOUIS -- The state Department of Mental Health is proposing the elimination of 484 state caseworkers for the developmentally disabled and retarded and replace them with private-sector case managers.

The department says the plan, which needs legislative approval, ultimately could boost the number of case managers, give them more time to interact with clients and improve their care.

"This is something that can generate more service resources," said department director Keith Schafer said.

But critics say the plan could do the opposite, exposing the system to penny-pinching, with private case managers putting the financial interests of their employers ahead of the people they are supposed to serve.

Alene Woodruff of Poplar Bluff fears the proposed changes could end an arrangement that has allowed her 23-year-old autistic son to live at home, with the help of round-the-clock care.

"It's all about the money, and it shouldn't be about the money," she said.

Under the plan, 200 caseworkers for the state's Division of Mental Retardation and Developmental Disabilities would be cut by July 2009. The remaining 284 would lose their jobs the following year. The caseworkers serve people with disabilities such as mental retardation, cerebral palsy, head injuries, autism, epilepsy and certain learning disabilities.

The state already has informed caseworkers to seek alternative employment. Schafer said the department has the authority to outsource case management, but legislators also must approve the plan as they consider the budgets of the next two fiscal years.

Schafer said the plan was born out of a need to reduce the workloads of caseworkers to no more than 40 clients each. Those ratios currently exceed 70 in some regions of the state.

He said outside groups can hire workers more economically than the state, largely because they can provide lower employee benefits than the state's expensive health and retirement plans.

Schafer said the new providers would be obligated to meet caseloads of no more than 40. Any money left over would be returned to clients in the form of additional services, he said.

But some county mental health boards, which the state hopes might take over case management, aren't too fond of the proposed change.

Joyce Prage directs one such board serving St. Louis County called the Productive Living Board. The organization, like more than 80 others across the state, was created under a 1968 law that allowed for local taxes to set up services for the developmentally disabled. The boards use the money to either provide services or award contracts to providers of workshops, group homes, therapy and transportation.

Prage said the St. Louis County board wants no part of case management. She said her board feels its job is to oversee services, not provide them.

The St. Louis Office for Developmental Disability Resources, which serves the city of St. Louis, already offers case management to about 500 clients. But the board's director, Barbara Searight, said the group is unlikely to take on more, fearing that state funds would not cover expenses in the long run.

Schafer said he expected that many community boards wouldn't want to take on the new responsibilities. As an alternative, the state wants to offer case management contracts to local service providers, such as organizations that operate group homes.

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Information from the St. Louis Post-Dispatch: http://www.stltoday.com