Sunday, April 13, 2014

Lingering insomnia

Forgive the long absence. My computer crashed, so I've been online less than usual. A friend was good enough to loan me his second-best laptop.

My new job will start May 19, not May 5. My last day at the current job is May 9. I came back to work on April 2. It was supposed to be April 1, but I burned my hand pretty badly on the metal handle of a pot I wanted to use to make hard-boiled eggs. The handle was too close to the kettle I had used to make my coffee. I showed the burn to the Employee Health doctor and reminded him that I'm expected to type and sign charts all day, so he gave me an extra day to recover. It still looks kind of bad, but since I'm not a hand model, that's not really important.

I gave notice on April 2. Nobody in my clinics was surprised, but almost all of them appeared to be sad that I'm leaving. I don't think the clinical director is sad -- she seems relieved. I have been out for several extended leaves of absence, so I can't really blame her.

Since giving notice, I've been walking around with a smile most of the time. I did have one episode of extreme anger: my disability paperwork took a few more twists and turns than I thought I'd have to go through. It's been a huge inconvenience and annoyance. When I learned that one page of my paperwork had never been signed by the department office manager, I got really angry and frustrated. I had to keep faxing pages and pages to the union, human resources, the clinical director... It felt like I was being deliberately sabotaged, and I was furious.

But I didn't do anything. I didn't yell, I didn't freak out. I sat down, reminded myself that feelings pass, tried to breathe, and put a cough drop in my mouth to distract myself. Later I went to the soul food salad bar down the street from the clinics and had some banana pudding. I like to think that it's a two-stage soother. First you have the sugar rush and the creamy mouth feeling, both of which give me a hit of instant gratification. But bananas and milk are themselves soothing foods -- so when the sugar rush crashes, you're sustained by the bananas.

Not sure how valid the science is, but it worked for me. And supposedly the disability payment is on its way.

I'm also a little frustrated with the CASAC process. CASAC stands for "credentialed alcoholism and substance abuse counselor." It was created to enable people who'd survived substance abuse and didn't have college degrees to become counselors. It's the lowest level of credentialing, but CASACs are Qualified Health Professionals (QHP). I've been a QHP since passing my LMSW exam in August 2008, but many social workers obtain the CASAC  to show that they have knowledge and experience in treating substance abuse.

To get a CASAC, you need a certain amount of education and a certain number of hours working in the field

In order to become a CASAC in New York State, you must: (1) meet specific competency and ethical conduct requirements; (2) meet specific work experience requirements; (3) meet minimum education and training requirements; and (4) pass the International Certification and Reciprocity Consortium (IC&RC) examination for Alcohol and Drug Counselors. All the stated requirements are overseen and/or coordinated by the Office of Alcoholism and Substance Abuse Services (OASAS).

If you have a master's degree, that's 2000 hours, which I've easily surpassed. The education was a bit more complicated to achieve.
  • 85 clock hours related to Knowledge of Alcoholism and Substance Abuse (must include a minimum of 4 clock hours related to tobacco use and nicotine dependence); 
  • 150 clock hours related to Alcoholism and Substance Abuse Counseling (must include a minimum of 15 clock hours specific to cultural competence); 
  • 70 clock hours related to Assessment; Clinical Evaluation; Treatment Planning; Case Management; and Patient, Family and Community Education; and 
  • 45 clock hours related to Professional and Ethical Responsibilities (must include a minimum of 2 clock hours of Child Abuse and Maltreatment Mandated Reporting and a minimum of 15 clock hours specific to ethics for addiction professionals).

Even though I have two master's degrees, there were certain courses I needed to take to fulfill the required education hours. Unfortunately, I never took a course entitled "ethics" in either program. In 2009, I asked the dean of my social work school to write a letter explaining how ethics is emphasized in every course in social work school:

I am a 2008 CUSSW grad working as a substance abuse therapist, and I want to obtain my certificate in alcohol and substance abuse counseling (CASAC). CASAC certification requires coursework in ethical and professional responsibility. While that was not the sole focus of any of my CUSSW courses, it was integral to almost all of them. One of my colleagues told me that if my department head writes a letter to OASAS explaining that the CUSSW coursework covers professional and ethical responsibilities, I won't have to take another course specifically to meet that criterion, especially since I have already obtained both my LMSW and my MA in forensic psychology.

I have taken the liberty of drafting such a letter, attached herewith, and would greatly appreciate it if you could help me obtain this certification. If you have any concerns regarding my proficiency in this area, I am sure that CF, who knows me well, can allay them.

About six weeks later she very kindly complied. But about that time I was promoted at work, got very busy, and didn't submit the application until December 2012, because OASAS was threatening that in January 2013, all prior coursework would not be eligible. They also required me to pay $100 for fingerprints.

So -- disappointing to learn, in April 2014, that prior coursework isn't being zeroed out, we will no longer be charged for fingerprints (but of course won't get a refund if we already got them), and OASAS thinks I need 43.5 more hours of ethics coursework.

After two master's degrees, including my MSW? Seriously? I don't need more coursework in ethics, because it's emphasized in every course during social work school. So I emailed my dean again:

3/14/14: Dear Dean Smith,

I hope you are well. A few years ago, you were kind enough to write me a letter in support of my CASAC application to show that I had completed sufficient coursework. When I was finally able to submit my application last November (I decided to prioritize obtaining my LCSW first), I received a CASAC-T and a letter informing me that I had not taken sufficient coursework in ethics.

I called the CASAC office and was told by reviewer JF that I need to submit an estimate of how much time in each relevant course was devoted to the discussion of ethics, including at least 15 hours of ethics for addiction professionals (which OASAS does recognize social workers to be), totaling at least 45 clock hours. The reviewer told me that an email from you detailing this would suffice to prove that I studied ethics while at Columbia. Her email is JF

I reviewed my transcript and came up with some estimates.

[list of course names and suggested hours of ethics discussion]

If you agree with my approximations and could email Ms. F at to let her know, I would greatly, greatly appreciate it. I am sorry to take up more of your time, but I am very reluctant to take more coursework on ethics when I've already been very well taught. (Not to mention the added cost, on top of the $100 application fee and $100 fingerprinting fee.)

Thank you so much,

Ayelet Survivor, MA, LCSW

She wrote back asking for some clarification on the hours requirements, suggested a few changes, and asked where I did my fieldwork. I wrote back to clarify:

3/19/14: Thank you so much for getting back to me. Basically, I have to show that I had at least 45 hours of instruction that were solely devoted to the discussion of ethics. So it could be portions of several courses that add up to 45 hours. 15 of those hours have to come from "addiction counseling" courses. I don't think they count internships.

I would suggest, based on your changes and questions:

[list of courses and hours]

That totals at least 45 hours of ethics coursework, including at least 15 covering addiction counseling. If you agree, you can send this to and I'll be eligible to schedule the exam.

Thank you so much for taking the time to help me with this. Once I get my CASAC, I hope to advocate that social work education be taken more seriously as providing sufficient ethical coursework for earning the CASAC.

And... silence. On April 4 I sent a brief reminder email:

Hello, Dean Smith. I apologize for bothering you again, and I know you're extremely busy this time of year, but I was wondering if you've been able to email JF at OASAS about the inclusion of ethics discussion in social work coursework. I greatly appreciate your assistance with this matter.

No such luck. She wrote back the same day to say:

Sorry, I haven't. I need to know definitively if they will accept the courses in field education. It seems like they should accept these courses.

"Field education" is what social work school calls an internship. I didn't think it really applied to the coursework requirements, although I definitely think it should apply to the work requirement. So I wrote back on April 6:

I don't think they'll consider fieldwork to count toward the ethics requirement. They might allow those hours to partially fulfill the hours of experience (2000 for people with a master's degree). Since I've been working for several years, I have more than enough hours. My two master's degrees, as well as several courses and trainings I've taken over the years, fulfilled all the course work requirements except for "ethics," since I didn't take a course entitled ethics at either program. I am trying to avoid having to take (and pay for) courses in ethics when the courses I took at CUSSW gave me a thorough grounding in ethics. The CASAC application processor said that if you will attest that several of the courses I took at CUSSW included some hours of discussion of ethics, including 15 specifically relating to ethics for substance abuse counseling. 

I am sure that if you email JF at JF and let her know that certain CUSSW courses include ethics discussion, and ask her whether field education could be used as partial fulfillment of the work hours requirement, she will get back to you quickly. 

As a reminder, this is how I think the ethics hours could be presented: 

[list of courses and hours]

Thank you so much. I've spoken with JF and she is very open to making the CASAC application process easier for social work school graduates. Your participation could go a long way toward making that happen.

And... silence. I am trying to be patient, which is not easy. I had to wait a long time for the job offer to become official; waiting for them to verify past and current employment dragged on and on. I've been waiting months for my disability payment. All I do in life is wait, even though I take as much initiative as I can.

Maybe that's why I'm still not sleeping well. Despite taking a very long walk yesterday afternoon and going to bed at 10 p.m., I woke up at 1 a.m. and could not fall back asleep. I'm not sure why the insomnia's persisting after Daylight Savings Time and beyond my recovery from other serious depression symptoms, like suicidal ideation, lethargy, and inability to shower. But despite a high dose of Trazodone, which is an excellent aid in falling asleep, I cannot stay asleep, and it's frustrating.

Don't get me wrong -- I'm grateful for a lot of things. I'm grateful for my new job and for the expressions of affection so many current co-workers have expressed. I'm grateful to see my nieces and nephew for the first two days of Passover. I'm grateful that the Apostherapy is progressing, although I still have moderate pain and discomfort. But I want to take that damn CASAC exam already. To maintain the LCSW and the CASAC, you need to take a certain number of continuing education hours. I want my license and certification to overlap so the courses I take will count toward both.

Patience is a virtue, and I am remarkably poor at it.
Copyright (c) "Ayelet Survivor"

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