Naja Harrell Druva is the kind of woman you want on your team. Choosing a career of service over one of wealth, she’s on the front lines of helping hundreds of children in Northern New Mexico work through emotional disorders. She earns less than $15 an hour in her 30-hours-per-week position, yet spends her own money on art supplies that help her clients overcome anxiety and troubles at home. Her husband is a schoolteacher, and the two believe in Santa Fe’s future.

But Druva is caught up in the state's behavioral health turmoil. It has her blood boiling. A new company took over the TeamBuilders Counseling Services treatment programs this summer after a still secret state audit that alleged widespread fraud. While it could afford to give employees at its Santa Fe office laptops to require more direct records data, newly formed Agave Health Inc. (created by Southwest Behavioral Health Inc. of Arizona) apparently isn't making enough money now from its mostly Medicaid-funded client base.

The company sent out an email last week informing hundreds of workers that their pay would be cut by 5 percent and that a new productivity measure requiring a "minimum expectation for direct service providers" of 75 percent would begin immediately. Druva says that amounts to her spending 6 hours of an 8-hour day providing direct therapy to clients in their homes with scarce time to travel between each appointment and less paid time for record-keeping.

"If I worked at a bank and they were doing this kind of thing, it would be easy to leave, but most of us here are doing this work because we care," she says. "In my core, I know what they are doing is not right. But I keep saying to myself that I don't really work for them. I work for these kids…Many of them have an adult who failed them, and I don't want to be another person in their life who disappears, who doesn't follow through."

Her clients range in age from 3 to 16 and live in all parts of Santa Fe, as well as Pecos, Glorieta and Taos.  Some get services because they've asked for help, but many see Druva's face each week because they've been referred for therapy by the Children, Youth and Families Department, a court, school or another public agency.

Druva, 35, earned her master’s degree this month from Southwestern College and has been working in direct services for children since an internship with TeamBuilders last spring. 

“We continue to provide the service, and it’s a good service, but it taxes the staff to do so. They are tightening the screws on us,” she says.

Agave’s email to its 350 employees at more than a dozen outpatient clinics and treatment programs across Northern New Mexico said the company was “operating at a significant loss.” Agave and four other Arizona firms took over services, such as drug treatment and suicide counseling, last summer from 15 New Mexico organizations accused of “credible allegations of fraud,” following a 2013 audit commissioned by the state’s Human Services Department.

The state auditor and others have raised questions about the objectivity and quality of the audit the state used as a basis for the fraud allegations and to suspend Medicaid funding to the organizations. Like TeamBuilders, many had to close up shop, replaced by Agave and the other Arizona firms. Transitions were not seamless.  

Druva said it was clear to her that TeamBuilders managers didn’t have a chance to address alleged deficiencies identified by the audit. Since the hurried meetings last summer where company officials told workers the business would have to be shuttered because the state froze Medicaid payments, counselors like herself have not received additional training or instructions about how to avoid federal compliance problems. 

“If I am doing something wrong, I want to fix it,” she says. “They are not letting us know what to fix.”

Agave CEO Dr. Heath Kilgore wrote to workers that the pay cuts and other changes were “necessary to preserve the services to our clients and the financial well-being of Agave and to prevent any further reductions, extensive layoffs or any site closures.”

Kilgore told SFR in an interview Tuesday that he and other administrators also took the 5 percent salary hit.  

“It’s unfortunate that the cuts have to be made, but that is where we are,” he says, noting that Agave has met challenges in  taking over staff from three  companies and consolidating them into one operation.  The Santa Fe clinic is one of the largest of its sites and employs about 80 people, he says. 

Asked if he was concerned that workers might feel stressed by the changes and that services for its more than 3,000 adult and child clients might be affected, he says:

“Anybody would be concerned, but I think it’s realistic. When you work in the helping profession, people are dedicated and that shows from the top down. We are looking to have a sustainable presence in New Mexico. We think people understand that that is why we need to take these measures.” 

According to the most recent federal tax documents on file with the IRS, Southwest Behavioral Services used more than $254,000 of its $52 million in annual revenues to pay its CEO salary. The CEO with the Arizona firm was earning about $7,000 more than TeamBuilders reported paying its CEO the same year. The first such report by Agave Health Inc. is not due until the nonprofit wraps up its fiscal year, but Kilgore says his salary is below that range.  

New Mexico In Depth contributed to this story.