2022.01.19 23:11 4o4_0_not_found Report: Bears 'very smitten' with Brian Flores
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2022.01.19 23:11 RocketElbow Anger And Advice
Good evening everyone,
This all just happened just as I left work today. Emotions are high, and I apologize for any spell errors, or moments of just making sense. This is going to be long, and rambly. I'm sorry for using this place to vent. There's a lot of exposition, but I promise, I'm going somewhere with this. Also, trigger warning, I'm probably going to mentions some disturbing content.
I'm not an angry person, I don't lash out, I'm good at containing those outwardly negative emotions until I have the time and place to work them out. I have to be like this for my job. I'm a clinician (LCSW) at a community health center, specializing in substance use and mental health. Specifically, my people are almost all dual diagnosis, meaning they have comorbid substance use disorders, and mental health disorders. Heroin and PTSD, Alcohol and Bipolar I, Schizophrenia and Cocaine/Crack, and every combination you could imagine. These are individuals who are too severely impaired or too much a risk to themselves/others to go to that sterotypical one-on-one therapist, and instead, need 3 to 4 hours of intense group therapy 5 days a week (PHP/IOP level of care) to stabilize before moving on to our weekly, and eventually monthly, maintenance(OP) groups. The work is challenging, a caseload of ~100 of the state's most ill and in-need people referred to us, with the expectation we will get them all on their feet. I wish it was that easy. The Clients are, again, are almost all on state insurance. It covers just about everything, but the expectations on us as care providers are intense, as they do want to see returns in their investments.
I've never lost anyone, not to suicide, or overdose, or even CoVid, but there have been a LOT of late nights talking people back from the edge. That's not even talking about the paperwork, an hour of therapy is 30 minutes of documentation for records and billing. There have been weeks I've done by 40 hours by noon Thursday, and as a salaried worker, I do not get overtime.
I started there as an intern, and got hired straight out of grad school. I'm Mexican/Chicano, and their Latino program needed staff. They had burned out one clinician after 5 months, another after 4 months, and they had to use a temp as a per diem to fill in until a permanent staff member came along. That temp, out of the goodness of her heart, worked for 2 years, without benefits. I was good at what I did, I was bilingual/bicultural, and I was happy to join. They were never going to let me walk out. And honestly? I wanted to stay. I made so many friends with the staff, I run the unofficial agency DnD game, I'm in multiple group chats with staff, we go out for dinner and drinks, it was great working with friends you connected with so instantly. We took a 4 hour road trip just to go to the vegan Mexican place one of my friends liked for her birthday. My supervisor was great, the learning was great, I thought I couldn't do any better. I just got my LMSW right after graduating, and I thought this could be a great place to get my required 3000 hours of work and 100 hours of supervision to qualify for my LCSW exam. If I passed that, I was promised benefits, a significant raise in pay, and faster PTO accrual. I felt like a king. I onboarded in May of 2019.
Then the world ended.
CoVid hit less than a year into my career. It was chaos, nobody knew what to do. How do we have group therapy when we can't be in groups? How do we document and bill when the state insurance our people have doesn't cover remote services? There were a few months when I had to call my entire caseload, one by one, to do individual therapy, because that was covered. State told us to figure it out, even if it reduced quality and quantity of care, as long as it didn't cost more. Individual Zoom therapy? I sleep. Group Zoom therapy? I WAKE. There were days I got in at 8am and didn't finish my paperwork until 8pm. This went on for 2.5 months until insurance decided to cover Zoom groups.
My coworkers are still supportive, but administration became dismissive. We were hemorrhaging money because our Clients stopped coming in. My direct supervisor works from home 3 days of the week, gets a day of PTO every 7 work days, and can approve her own time. She's validating of our struggles, but the bottom line is "get it done." Her validations are what she offers when she can't offer solutions. I can't tell you how many times I've been volun-told to do more work, take an extra intake assessment, revisit treatment plans, do state evals that do NOT help my people, but it's data that state likes to see. I had a Client miscarry for the second time, call me in a full blown mental breakdown, and when I was not able to immediately respond to my supervisor, she asked me to tell my Client "make an appointment for later and transfer to crisis, you need to do an intake."
My people are genuinely good people in bad situations, doing what they can to get better and heal. The issues they have are systemic and personal. Refugees, sexual assault survivors, veterans, people struggling with substance abuse or self-harm. I sincerely believe the cure for depression and addiction is connection. Humans are social creatures, we live to be heard and to listen. The human connection, my ability to empathize and resonant with my people is the single strongest tool in my kit. Now I had to segment people in hardline 15-minute spots, over the phone, without visuals. If someone tells me the used that morning and feel sick, I can call a medical code and they can assess and call 911 if needed, every doctor or nurse in the building shows up. If they're feeling suicidal, I can call our crisis department and get a mobile intervention for an assessment. I don't have any of those tools over the phone. I had a suicidal client "in a park", refusing to give me more details, and when I called 911 to report, they told me there was "not a lot that we can do" without a concrete address, other than an alert to their patrols. I had the fewest, weakest tools, right as my Clients, my people, needed me the most. Then we lost 3 of our 5 Spanish speaking clinicians as they burned out, and their Clients became my Clients. It's been two years. Not a single applicant for a Spanish position. The one we had for English rescinded his application after he was told what a typical caseload was. The remaining team is crumbling and looking to get out.
I went from monthly sessions with my own therapist sessions, to biweekly, to weekly. I'm testing positive on PTSD screeners. I'm snapping at my girlfriend, I'm isolating and drinking, I'm crying or yelling before I even realize, I'm loosing compassion for my Clients. I've been spit on by my clients, threatened physically and sexually, yelled at for minutes on end by them. I get it, they're ill, I get it. But that explains, it doesn't excuse it, it doesn't make me hurt any less. I wake up some nights in a cold sweat, panicking I forgot something or failed something, and I lost someone because of that. The pressure of worrying if someone has died because of me is breaking me. It's been 2 years of this.
Financially things have been tough. About 50% of my budget goes to rent, the rest to bills, and I have maybe $150 a month for spending on little things, taking my girlfriend out, sending a little to help my immigrant mother after she broke herself and destroyed her credit to give me that shot at "The American Dream." If I had to pay my student loans on top of that, I'd be unable to cover my bills. I'm able to pay my bills at the moment, but I can't do anything else. I've never had more that $2000 in savings, despite 8 years of schooling, $130,000 in student debt, and earning at the upper level for someone with my incomplete license, the LMSW, not the LCSW. When my credit cards got bad and I had to increase my monthly paymenys, I had a whole $9 to play with in October, and $17 in November. What kept me going was the hope of all those promise things would get better after passing my exam, getting a raise, and being able to live, not survive. My girlfriend passed her LCSW in October, and got a job making $70.5k. I'm so proud of her, we cried together when she got her offer letter.
I passed my exam 2 weeks ago, I got my full liscensure. And an offer for $60k. A 7% raise. For context, I was verbally told $70k, "at least 20%" which is the same the rest of the LCSWs on the team get. Our most recent clinician to leave got $68k as an LMSW at her new job, an incomplete license, and holidays off and faster PTO accrual. As an LMSW.
I'm not writing all this to fellate myself, I recognize I'm extremely privileged and I need to check that, but because this place has destroyed my own mental health, strangled my love for people that got me into this field to begin with, and then had the audacity to turn around and give me an offer my coworkers called "insulting, because you're the one keeping an entire program running."
I'm going to decline the offer, and keep working there until I find something better. I've flirted with the idea for months, but after today, and finally passing my exam, I have the means and the motivation to do it. It's extremely hard to find a good job in this field with only an LMSW. I've had 6 hits since updating my Indeed profile yesterday. I know what I'm worth, my girlfriend, my coworkers, area agencies, they all know what I'm worth, all except my current employer. I'm the last Spanish speaking clinician for our Latino IOP. If I go, that program goes with me, the other Spanish speaking clinician is on record refusing to take on any more work on. I do 17 groups per week, including my Latino IOP. At my prime, I was making the agency $72,000 a month in IOP billing alone, before my other OP groups. I'm going to refer my people out or gently transfer them to any other clinicians willing to take them on.
I hate myself for choosing to leave, I feel like I'm abandoning my people, but I keep looking at the train tracks down the road from me like they're appealing, and if I stay, I'll forever burn out. Or worse. I'm sorry, but I hate my workplace more than I love what I do, and that is not ok.
Getting back to the title of this post, does anyone have advice on what to do next? Am I making a mistake by declining that offer? Is it dumb to keep working there like nothing happened? It feels like a good plan, but I'm so full of emotions, I can't tell what's the right call. What should I do? What did I do wrong? How do I fix it? How do I become better?
Thank you for your time. Be well, and be safe.
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2022.01.19 23:11 geobadzo VMware Workstation 16 Pro
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2022.01.19 23:11 2Deviously Look at the pro israeli cringe that’s being pushed on the fyp of tiktok
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2022.01.19 23:11 Background_Level_889 I’m looking for a book about djinn, jinn or genies.
So I grew up Christian not Muslim, nor have I’ve had any exposure in backgrounds that involved genies religiously or culturally.
However I’ve always been interested in stories about genies. Technically I’m looking for some non fiction books about genies, most of the books I can find on them or limited. Either they are from a person with no background like myself for all I know they could be making stuff up or have stereotypes play a factor in what I’m reading. Or they are like How to control a genie in five simple steps! Or using jinn magic. I don’t know if these are conspiracy books or cash grabs or to what respect. So a book that might mention their background, and how they might be presented in the Muslim text, religion and culture and where did these creatures originate and how are they? Or just any culture that has them?
I don’t mind fictional stories either, but like I’ve already stated these could be stories that are almost fetishized of certain cultures, or written from a different curtal perspective and due to my own background I can’t tell the difference between which one would be more accurate and more stereotypical.
I’m sorry if I seem vague, I may not know how to phrase the question.
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2022.01.19 23:11 Internet_Kid99 Nothing crazy but I thought this strip was photogenic enough
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2022.01.19 23:11 sumonespecal For people that think aliens are good for us.
Exactly why would you think that and what have you researched that make you believe they are good for us?
To me, according abduction experiences, whether true or not, aliens don't have a peaceful reputation. When good experiences happen it seems they are implanting false memories through neurological engaging.
Although whether they are good or bad, I do think it's pretty cool that there might actually be intelligent life out there apart from us, whether they are aliens, demons or fallen/ angels.
A few facts from abductions: Almost no one has been killed apart from some cattle/ human mutilations or people dying from fear after an abduction from a heart attack or are mentally controlled in doing harm to themselves or others. Aliens seem to be wanting us to take good care of the planet, which would be considered a good thing. On second thought, they are also interbreeding and try to replace us and make the planet for their own. It's a stealthy invasion, would you accept that even though it's our own habitable planet? Impregnating you against your will, rape have been reported or physical abuse for not cooperating, mentally control you without you realizing. Yes we humans have some work to do but it's our nature our future, I'm against what they are doing, I'm just curious in how would you approve of something like this and at the same time say aliens are goo for us.
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2022.01.19 23:11 nmnel56 24 [F4M] #Bloomington Drop your load in my mouth 💧let's go freaky today.. Be my Dad 😩🍆
Looking for a big tit guy! I loooove having my tits sucked licked and nibbled. Looking for someone who can do this for me. Ideal date: suck my tits in public in the car or at a movie theater or come to me.. Worship them, make me wet
Ideal guy: Same age good looking, willing to suck on my tits 😝 and only that and I'll like to have a good time with someone who appreciates a nice fat ass. I've been lucky enough to get mine worshipped before and I loved it, was put in all sorts of positions so that they could admire.50 is my limit, and nobody under 18. Looking for a CNC feel to this. Include at least one thing you’d want to do for you. I sext too ,nuru massage ,I don't wanna go hard but 😏I'm gonna drain your balls
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2022.01.19 23:11 widmerpool_nz Train Reread - Chapter 3
Whereas the first two chapters were headed with a place and date, this one is titled 'Norah' and tells us the place is a boat in Newport Marina.
Norah is young and is unhappily married to Alec, a much older, rich man whose kink is watching her having sex with men her own age. This passage describes her well:
One way or another, men had been trying to protect or save her all hr life. She brought that out in them, even after she had stopped trying.One night, the ship is boarded by two robbers, who shoot and kill the captain first and then slit Alec's throat before raping her.
2022.01.19 23:11 bot_neen Pipa cargada de diesel se estrella contra una casa particular
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2022.01.19 23:11 Td4Ba Free use Pakistani in traditional clothing
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2022.01.19 23:11 reluctantbunnyboy Recently I remembered when I was a kid I would play “safari” with my younger brother
I would take all my stuffed animals outside and hide them in bushes hand them from trees put them all around and then we’d get into his little jeep thing and I’d drive us around and narrate the animals like a safari driver.
My brother is 8 years younger than me so I never really had to many memories of us as kids but this made me smile
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2022.01.19 23:11 yosoyjulian Scream box office predictions?
I know this has been discussed before, but now with the confirmed box office numbers over the weekend, how do you think the movie will do at the end of its run?
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2022.01.19 23:11 tradeboss_ "fatherless"
Ugh. I feel very uneasy writing this. Maybe it's bc I really do not like to express my emotions nor how I really feel. About 10 years ago my "father" decided to leave my mother, sister and I after cheating on my mother. I never cared to build a relationship with him while the divorce was happening and to this day, 10+ years ago the relationship between him, my sister & I fully disintegrated. He started a full blown new family and never even calls to even check up on his first children, no happy birthdays nothing. While it does hurt to technically not have a father no more, I always have a feeling of emptiness within myself and I'm not sure if it is related to being "fatherless" but at the end of the day I can never forgive him for the pain he put us through. It makes my heart hurt knowing the pain my mom went through, but as the eldest I feel obligated to pick up slack & help her. How he treated my mother fully turned me off from ever starting a family of my own and or ever getting married. Is this normal? How can people abandon their kids and not care?
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2022.01.19 23:11 WallStBull10Point0 The Efficacy of Therapeutic DNA Vaccines Expressing the Human Papillomavirus E6 and E7 Oncoproteins for Treatment of Cervical Cancer: Systematic Review 🧬🌎
Nowadays, despite the treatment of locally advanced disease with chemoradiation, patients have a high recurrence rate and a poor 5-year survival rate, estimated at 50% and 70%, respectively. In contrast, the MEDI0457 vaccine, which contained VGX-3100 plasmid coupled with an IL-12 expression plasmid to promote T-cell function, evaluated the disease progression-free survival (PFS) at 12 months, which was estimated as 88.9% overall. These findings strengthen the hypothesis that DNA therapeutic vaccines could effectively induce de novo or boost existing immune responses. Moreover, studies have shown that using femtosecond laser treatment could also improve transfection efficiency administered intradermally and into the lesion in vivo. Thus, continuous efforts to improve the efficacy of DNA therapeutic vaccines and implementation of therapeutic vaccines into a treatment regimen as a sole approach or in combination with conservative treatment may greatly improve the current situation.
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2022.01.19 23:11 Internet_Kid99 I made a massive Swiss roll instead of leaving my apartment
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2022.01.19 23:11 BackhandQ Vince Carter - "If I do have that opportunity, it would probably be as a Toronto Raptor" (re: HOF) ~ [in his new documentary]
Not sure if this has been posted here as yet, but there's a documentary out on Amazon Prime that covers Vince Carter.
A lot of the same themes that we've heard, seen or read in the past. But still a decent watch.
Title: Vince Carter: Legacy.
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2022.01.19 23:11 Sovereign122 Will DMT affect my life path and/or cause me to change the course I am currently on?
Hi all! I'm planning on doing DMT soon (possibly this weekend) for reasons of spiritual/intellectual exploration and curiosity, and because I'm always interested in what there is to learn from altered states of consciousness. However, I've read about the intensity of this trip and I've had bad trips in the past with other psychedelics that affected me greatly for months later. I'm currently applying to medical school and feel like I'm on a good path in life, which brings me to my question: if I trip, will it negatively affect the path I am currently on and if so, (how) can this be avoided?
Much love and thanks in advance to those who take the time to answer!
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2022.01.19 23:11 chammies_ I’m down so bad for this girl. Ran really gets sick from eating too much, likes cleaning and is a tsundere. She is so cute I love all her scenes. I am very excited to marry her 😍
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2022.01.19 23:11 Pro-Rider Zero has a new electric motorcycle model coming, and here's the first image
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2022.01.19 23:11 SKYILOVECAT Meow
2022.01.19 23:11 AsapSandman Go watch this kid hes crazy nuke gameplay
2022.01.19 23:11 NoSteak4272 Last chance to talk to my crush
So I made a post a while back talking about how I had a hard time talking to my crush for the first time. One day on my way to lunch, I asked her about the exams we had just taken. She responded, but the conversation kinda ended there. It was atleast a step forward, and I was gonna keep talking to her, but then it was winter break. It wouldn’t have been much of a problem, since I would see her after break again, but things got messy. Due to low staff and snow school was virtual for about a week. The next week we could choose to go physically to school or virtually, she went virtually. And now this is finals week. I have two classes with her and I was going to talk to her today, since it’s the first time I’ve seen her in almost a month, but I was to shy to talk and the chance passed. Now I still have a class with her tomorrow, so we can do our finals there, but after that, that might be the last time I see her in a while. You see, the semester ends this Friday, and if she decides to do virtual on Friday, tomorrow is the last time I’ll see her, since next Monday I have brand new classes, and she’s in none of them. No I was planning to talk to her today, tomorrow, and ask if she was going to school on Friday, but that didn’t exactly work out. So now I just have one class with her, and majority of it is going to be silence since we have to do our final exam. The only real way I can keep talking to her is if we give each other our numbers, but it feels awkward asking someone you barely know for their number. I’m aware that almost all of the semester I went without saying a word to her, but we acknowledge each other’s existence at the very least. I don’t know what to do. I feel like I missed my chance and now it’s too late.
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2022.01.19 23:11 bbwat Whirlpool reverse osmosis won’t stop running drain line. Replaced diaphragm inside unit with proper part and still runs, even when tank is full. Thoughts?
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2022.01.19 23:11 ManufacturerNo7356 U.S. Supreme Court spurns #Trump bid to keep Capitol attack records secret
U.S. Supreme Court spurns #Trump bid to keep Capitol attack records secret
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