case manager

outpatient therapist

recovery specialist

assertive community treatment team leader

customer care specialist

4C Health

I was initially excited to work here due to what was described about the culture and the nature of the services provided. I was also impressed by the efforts that seemed to be made by upper management for relating to employees, improving things and expanding services. However, I was disappointed to discover that the work environment is nothing like they promote, and most things are nothing but lip service. If you are considering working here please read carefully and weigh all your options. I would only advise someone to work here if they are desperate and need something to hold them over until they find something better. 

First, this place is run by upper management who have ethically questionable relationships that present a huge conflict of interests. This makeup is dysfunctional and flows over to how the organization is run. Upper management are also micromanagers and insist on having their hands in everything. Upper management micromanage everything to the point that more time is spent reporting on what you do than actually doing it. They then do not understand why so little is able to be accomplished. Their style of micromanagement stifles growth, innovation, critical thinking, strong independent decision making and instead of encouraging and promoting empowerment, it kills it. This leaves you with a problem that is rampant at Four County; no one wants to actually make a decision, give a definitive answer to something, speak up about problems or take responsibility for ANYTHING! Various people in upper management often give vague and conflicting instructions and expect you to appease them both or suffer the consequences.  

Secondly, the culture at Four County is toxic, hostile and suffocating. This is the result of a climate that values micromanagement and punishes anyone with an autonomous mind who practices critical thinking, independence and innovation. Whenever someone attempts to take initiative or provide honest feedback, they are quickly shutdown and often reprimanded. I have not only experienced this personally but also witnessed it countless times. 

Toxic and hostile people within VP and Director roles bully, threaten and harass everyone around them. They are continually encouraged and rewarded which promotes all others to in turn point fingers and place blame on those around them to deflect blame on themselves. Everyone is afraid to stand up to such people as it is obvious they are favorites of upper management and, therefore, can do no wrong. This sends a clear message to everyone else that they better bow down or leave. Communication and cooperation are non-existent here. Everyone is either suspicious of those around them and how they will be stabbed in the back if they say the wrong thing to the wrong person or actively looks to further themselves at the expense of anyone else. This place feels like Survivor as everyone is looking out for themselves as they struggle to just make it through another day. 

Thirdly, most people are given constant and unreasonable expectations that are impossible to meet. Those above want to dictate and criticize how long things take to complete when they have no idea whatsoever of how long such tasks take or how complex and in-depth they are. When these expectations are not met, individuals are then punished or threatened so that they leave before they can be forced out. While this seems to be a special tactic that is used to get rid of those who are no longer wanted (those who fall out of favor or seem to get too old), it is not reserved just for them. This is also paired with the fact that when people leave (which is constant due to all these conditions) they are often not replaced and the work is just spread among everyone else who is already overworked, overburdened and burned out. 

There is also no plan for easing most people into their positions. People are thrown into their jobs full swing and given the option of sink or swim. While getting into a job is the best way to learn it, Four County does this in a way that more often than not sets new people up to fail rather than succeed. When people then stumble and struggle they are not supported by those above them in a manner that seeks to help them succeed. Instead they are criticized, belittled, demoralized and reprimanded. People who have only been in their position for a short time are expected to be experts at it and never make mistakes. 

Fourthly, one of the things I found personally difficult for my department and position was that when first starting I was told that the organization and upper management values feedback, growth and innovation. I was told that they wanted new ideas on how to improve things. I gave a lot of feedback and ideas. I would then hear from others that the same information and ideas I was providing had been provided numerous times by other people but ignored. The same information from me would then be ignored. I would then watch others come after me, hear the same message, provide the same feedback that would still get ignored. 

However, if you can tolerate many of these conditions you can realistically move up/around and pad your resume as positions are constantly open allowing for movement. There are a few good mid-level managers, unfortunately, they are just not enough to outweigh things overall.

Additionally, the benefits here are very poor. Pay is super low in general and even more so considering how much you are expected to do and the amount of stress you have to deal with. Insurance covers very little and is super expensive. You could participate in the wellness program but all the labs and exams to determine your rate (with the hope of lowering it) falls on you which detracts from the amounts you are hoping to save. Holiday, PTO and 403b (retirement) are not bad. 

Overall, this place is not worth it. There are so many better options out there. This is what most people come to realize very quickly which is why they have an insane amount of turnover and are unable to keep anyone for long.

I worked for this organization for more than 30 years and recently retired from the ACT program. What follows is my honest experience.

When I started, the company felt mission-driven. Staff were empowered to make decisions, teamwork was encouraged, and client care came first. Over time, I watched the culture change. In my opinion, productivity metrics, documentation requirements, and financial performance gradually became more important than either employee well-being or meaningful client care.

The company heavily promotes its four-day work week. On paper, this sounds excellent. In practice, staff are still expected to maintain productivity standards that can be difficult to achieve when clients require transportation to medical appointments, crisis intervention, or other time-intensive services. A single specialty appointment in Indianapolis can consume most of a workday, yet the productivity expectations remain unchanged.

Documentation requirements have grown substantially. Notes are reviewed by multiple layers of auditors, often with different expectations. Many employees spend significant amounts of time trying to satisfy documentation requirements while also maintaining full caseloads. The resulting stress level is considerable.

Communication has deteriorated significantly compared to earlier years. Information that was once routinely shared among treatment team members often feels difficult to obtain. Staff constantly feel disconnected from decisions that directly affect their clients and their work.

Employee benefits have also become less desirable over time. Insurance costs have increased, deductibles remain high, and several long-term employees have expressed concerns that seniority and institutional knowledge no longer carry much value within the organization.

Another concern for many employees has been the contrast between frontline working conditions and executive compensation. According to publicly available IRS Form 990 filings, executive compensation has been substantial, with the CEO receiving compensation in excess of $450,000 annually and other senior executives receiving compensation ranging from approximately $180,000 to more than $450,000. Employees are free to decide for themselves whether that compensation is appropriate. However, it can be difficult for frontline staff to reconcile rising productivity expectations, increasing documentation requirements, high insurance deductibles, and reduced benefits with executive compensation levels of that magnitude, even with annual bonuses. It doesn't help when the CEO & CFO are a married couple, either.

The most disappointing change for me has been cultural. The environment increasingly feels driven by numbers, productivity targets, and compliance measures rather than collaboration, staff development, and client-centered care. Many talented coworkers whom I respected have left, and many of those who remain are actively exploring other opportunities.

This is not to say that there are no good people here. There are many dedicated clinicians, nurses, therapists, case managers, peer specialists, and support staff who work incredibly hard on behalf of their clients. They deserve recognition for the difficult work they do every day.

I retired because the stress associated with the job and organizational culture eventually outweighed the satisfaction I once found in the work. For someone considering employment here, I would strongly encourage asking detailed questions about productivity expectations, documentation requirements, supervisory support, turnover, and work-life balance before accepting a position.

Pros:
• Four-day work week
• Dedicated frontline staff
• Meaningful client interactions
• Competitive mileage reimbursement

Cons:
• High documentation burden
• Strong focus on productivity metrics & profit
• Communication challenges
• High stress levels
• Frequent turnover
• Limited recognition of seniority and experience

I once considered this a wonderful place to work. I no longer do.


I worked at 4C for a couple of years working as a Community Based Case Manager (Skills Trainer). Typically my case load was about 15 adult/child clients along with a few DCS clients. The training provided by the company is lacking, although they do allow you the opportunity to shadow other employees to see how they complete their job the first couple of weeks. 

The company claims to have educational material for children to use with your clients, however it's typically not age appropriate with children under 6. You'll get clients as young as 3 years of age so you'll have to spend your "time off" from work to locate and print out material. Finding relevant material for children and adults is time consuming and was an added stressor to an already stressful job. 

The only benefit to this job is that you can make your own schedule, however when you have kids on your caseload you have to work around their school and extra curricular activities which left me working up to 8:00-8:30PM some nights. There would be required meetings in the mornings typically around 8:00AM which makes for an extra long day. There were days I'd have meeting at 8:00AM, then seeing clients in the morning, afternoon and into the evening and then have to complete progress notes. The company focuses on "billable time" which adds to your daily stress of working with a difficult population as it is. Employees are disciplined for not meeting their metrics and this seems to be 4C's only motivation instead of it's staff providing quality care. You're expected to complete all notes the same day, along with DCS monthly reports due on certain days and treatment plan updates. The paperwork and extra reports seem like they never end.

There's supervision meetings with therapists who are supposed to provide suggestions on helping with difficult clients and their situations, however the suggestions often times are ones that have already been tried and are sometimes too generic to be helpful. 

Although this job is rewarding at times with helping people improve their lives, it's also filled with many stressful and disappointing events. I was also unprepared for having clients who are lowering functioning, i.e. nonverbal and highly aggressive, people who I believe are better suited for different service providers other than community mental health.

The other major stressor is being community based means you're going to these people's homes which is not very safe in many aspects. I've been in homes where cockroaches are crawling all over the place, so obviously it forces you to take clients out someplace else. However, this again runs the risk that these people are bringing bugs into your car which will then infect your own home. With bed bugs being so prevalent and on the rise I felt like each client and each new client was a constant threat to my own house and family.  I also had clients who were verbally aggressive and made threats. There were also clients who would at times be under the influence of drugs or would have sketchy people in their residence which was also scary at times.

The turn-over at 4C is quite high but they constantly hiring new people who are fresh out of college. If you're passionate about wanting to help other people with a focus on mental health this would be a decent stepping stone to a better job. As Skills Trainers we are the ones doing all of the work with little pay. The health insurance is extremely expensive even with the wellness plan and at the end of the day the pay just doesn't make it worth it. 

There is holiday pay which is nice and you accrue paid time off, however there's no sick pay so you're forced to use your PTO if you get sick. Also if you schedule a vacation you have to find coworkers to cover this which is not always easy.  The company wants to talk about the importance of self care, however when you try to use PTO it's an added chore to find somewhat to complete your workload while you're gone.

I love working with my clients and serving the community. Clients are the best part of my job here at four county. Four county does a lot of good for the people that they serve and I am so happy to be a part of this team. 
Things are always changing some for the best and some I don't agree with. I find it hard to voice these concerns with management at times as I don't know if they understand as some are not working in the field and seeing what some changes do to our clients as they are more behind the senses. Some voice "Things are always changing so clients need to be use to this." As I do agree to some extent on this, but not with everything. Due to turn over rate some have had 4, 5, or even more workers. Yes we can't help turn over rate. You need to be very flexible with this job and be able to adapt and overcome. 
Like I said there are good changes, 32 hour work week with 40 hour pay and same benefits of working 40 hours. That's amazing. They do care about their employees. They promote self-care and PTO, you earn so much after being there for a while. There is never a reason why you can't take a week off or a day here and there and still have soo much PTO for yourself and your needs. Not to mention flexible work hours. If you need to clock out and go to an appointment you can do that, and then come back to work. That is amazing.  
Now with changes, not everything is going to be great and awesome. With that being said along with the 32 hour work week coming that means staff that are in a dual position... they are being forced to one position, (sounds great) but this is where I don't think client care is being met. We are forcing some client's to change skill trainers because we want them in one department and now these clients have to choose if they want to keep services with someone else or drop services. Which can be hard when working with kids/adults that you have built a relationship with that needs the same schedule and for you to show up when no one has, as well as know their story. You have to tell them you are no longer working with them because you was told you can't keep them because they don't want staff in two positions anymore. I don't know if this is really client care, and it's not only stressful for the client's but the staff to, because staff is the ones telling them this information and now client's and their families are upset and don't understand as these staff are still working for the company but can no longer have their skills trainer's that they have built that trust and rapport with, who they are comfortable with, and who has showed up for them week after week. So needless to say they have to start over with someone new, tell their stories once again and work on being comfortable with someone else. 
Trying to be the voice for these clients and their families and speaking up has been difficult when discussing this with management. We are told we are here to advocate for our client's but it's hard when management won't listen to you, and seem that it is not big deal if the clients stay in services with someone new or want to be discharged.
I will continue to show up and advocate for my client's because if we don't who will. This is what we have been trained and taught to do. 





I have worked here for several years now and I feel that it is just getting worse and worse. I used to really enjoy coming to work, now I find that I literally get sick thinking about coming to work. The changes over the last couple years have not been positive and I feel that there is so much favoritism in promoting people that the actual people with the skills are not getting promoted because they are not friends with the right people. I do not feel as if my voice is heard, even though one of the values is to "speak up". I feel like I am being placated when I bring something to my supervisors attention and then one of two things happens: 1. Nothing gets done and my concern/idea/request goes ignored or 2. The person I take it to takes it to someone else as their idea giving little to no credit to anyone that actually does the job and address the need. 

Also, morale is so horrible that you can physically feel the tension when you walk in the various buildings. At one point they had someone trying to boost morale through emails, but that person has not sent any in awhile so I assume they are probably gone as well. the expectations are unrealistic which leads to complaints from clients and a constant rotation of employees...unless you are one of the chosen ones who can degrade and belittle your staff and still get treated like your the best manager ever. Even the VPs cant get along. I have heard at least 2 of them make remarks about other ones. How are we supposed to like our job and feel empowered and hopeful when upper management is tearing themselves apart at the seams? And speaking of upper management, while another person addressed the conflicts of relationships in upper management and Four County responded to it, it really is an issue. They may have been vetted through a bunch of legal people, but they cannot separate their roles which has most of the company feeling like the children of a nasty custody battle. 

Pay wise- My position I feel pays ok for the most part, but I know other positions haven't gotten raises in years and when they ask, are told that they are already over paid. Some managers are managing positions that they don't even know how to do and do not have their staff's back. Unequal pay and management would be the top reasons I am looking for another job.

The prescreening process for this job was pretty massive, but honestly, it has to be due to the responsibility you will have in your position (drug test, background check, vehicle inspection, etc.). In my experience and what I witnessed, this job is often pretty easy to get considering it's role of responsibility. There seems to be a continuous lack of applicants comparative to open positions within the company. The training that you will receive for this role is not nearly as much as you should have. You spend two days at in-person orientation and then you pretty much shadow for the next week. You learn a lot during shadowing, but you start off with little to no comprehension of the variety of responsibilities that you will have in this position. Luckily for me, my coworkers were very genuine and helped me wherever I needed it. You may want to only work with a specific age group, but you will likely find that you will have a caseload of a variety of ages, especially if you are working in a county where Four County is less prevalent. The more prevalent Four County is in a county, the more likely it is that they will be able to split up SKT's by age group. I went in without a preference and I ended up with as varied of a caseload as my coworker who went in to strictly work with 3rd graders and below. In my experience, Four County management struggles to document and update caseloads of SKT's. I was literally the only person who knew my entire caseload. This job has a LOT of responsibility. And your caseload can make or break your enjoyment of the position. Some people don't want help. Others will be in such a bad environment, that it will be emotionally draining for you during every interaction. However, with all of the negatives, this is a position where you can truly change the lives of many individuals. Many clients that you have will simply not have someone to talk to. You can find that you can pretty quickly begin to help these people become better. If you don't care about the money and you truly want to help people who are struggling, then this job can give you satisfaction.

Four County has been my home away from home for many years.  It is not for the faint of heart.  A person working here has to be mission-focused first and foremost.  Otherwise, the demands of working in the field of community mental health will overwhelm you.  A person has to have a heart and passion for serving those individuals and communities within a community mental health center.  We are a critical access point for the most vulnerable individuals in our communities.  This comes with many challenges but also with many rewards.  What has kept me at Four County, other than being mission-driven and called to rural community mental health, is Four County's flexibility, opportunities for growth, and the family-friendly culture it provides.  My spouse has worked for several different companies throughout our marriage, in a similar field, and I can tell you, that other companies just aren't as flexible and family-friendly.  It is rare and is something I am very grateful for.  Is Four County all roses all the time?  No. There is stress that comes with the type of work that we do and the ever changing terrain of healthcare, etc.  Is everyone nice and friendly all the time?  No.  Am I never stressed?  Absolutely not.  But if a majority of my life is spent working, I better choose to be doing something I enjoy and find rewarding and I shouldn't base that satisfaction on external factors.  As I tell my children every morning, "a good day is a choice."  If you are looking for a place that expects excellence, encourages growth, and is flexible to your needs (within reason), then Four County is the place for you!  Come grow with us!

I have been with Four County for 6 years.  I started my career with Four County as an entry level Skills Trainer.  I was able to build upon my career and have advanced to a management position.  As with any mental health career, it comes with its challenges.  Mental health is a tough gig.  You are dealing with humans who will make progress and will also relapse in their treatment.  That part of the job is tough.  This field also comes with some great rewards.  Seeing clients graduate from high school that were planning to drop out or gain full-time employment and a place of their own are some of the victories that you are able to celebrate with them.  
In recent years, Four County has been in the process of creating a cultural shift that focuses more and more on better care for clients and making a greater effort on training staff to be able to come along side clients and help them to help themselves.  Our goal for most of our clients is for them to gain the skills necessary to not need us anymore.
Four County has also recently implemented new core values to improve the culture and atmosphere for employees.  Be Kind, Be Agile, Speak Up, and Own It are the core employee values that are currently being built up and being adopted by all employees.  I can't think of any place that wouldn't benefit from these core values.  I feel like I have a wonderful work family that all truly care.  I also feel that I have the flexibility most of the time to work and take care of my own family's needs.
If you want a career that is rewarding, requires you to think on your feet, aren't afraid of putting in effort, and want to make a difference in people's lives, Four County is the right place for you.

When I first started I absolutely loved it! I felt like everyone from the CEO down cared about all staff. Once he left, the climate changed drastically. Case managers got raises, while therapist, support staff, and client services specialist didn't get anything, and many got "demotions" because they are not viewed as money makers. 

Also, the amount of training has gone out the window. People are written up or fired for not knowing how to do parts of their jobs because no one ever showed them. This has also shown in terms of supervisors playing favorites. If you are a "golden child", it doesn't matter if you cuss at clients or turn notes in late. But if you have upset the supervisor, you get in trouble for sneezing wrong. There is no more unity or team work. It's everyone for themselves, which has created an atmosphere of backstabbing and tension.

There's also a great deal of micromanagment that goes on which makes it difficult to maintain unrealistic goals. Time is taken away from your family too make sure notes are done on time but then you have to have them approved by a supervisor first, so then you get in trouble because your supervisor does not always approve them in a timely manner and then they are late. 

The one thing good I can say is that as a case manager, you can make your own schedule which can be nice, especially if you have small children. But overall the stress, low pay, backstabbing supervisor and unrealistic expectations make it a pretty horrible place to work.

If you want to have no work life balance, hate your life, experience high levels of depression and anxiety, this is a great place to work. My hair started to fall out, I had to start blood pressure meds (for my high BP) and was put on the max doses of 3 different anti-anxiety/depression meds. My MD begged me to quit. 
Higher ups have unrealistic expectations and employees are disciplined when they do not meet such expectations. As a therapist they try to cram in as many people as possible into one day; very clearly valuing quantity (i.e. more people per hour=more money) over quality care. They claim to care about their employees, and some do, but many just care about the “bottom line.” Get your insane amount of work done in this unrealistic time frame or be disciplined. The work load increased throughout my time there so therapists were doing case management type jobs on top of everything else. Management decides workload and time frame but is very out of touch with what is actually involved, which leads to the unrealistic time lines. Management does not listen to employee feedback about this and only continues to increase the work load (without increasing pay or any type of incentive). You will get paid more elsewhere. At times I had over 15 people in my schedule per day. This was typical for many people, not just me. There is no work life balance and no way to have work/life balance because you must take work home in order to even try and meet their unrealistic deadlines and workloads. 
The clients and coworkers were the best part but after awhile the burnout is too much. Turnover is very high for a reason. Toxic environment with micromanagement. 


Top Job Titles	Average Salary
Case manager 72 salaries reported	$23.06 per hour
Outpatient therapist 22 salaries reported	$92,500 per year
Recovery specialist 17 salaries reported	$25.64 per hour
Assertive community treatment team leader 13 salaries reported	$26.01 per hour
Customer care specialist 5 salaries reported	$21.13 per hour

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