Thursday, December 31, 2009

Your Face Sounds Familiar to Me

As I'm walking into our agency's main lobby a woman turns from a staff worker and asks me (before I say anything):

"Didn't I talk to you on the phone the other?"

Wednesday, December 30, 2009

Book Review: Scratch Beginnings

While reading a review about Nickel and Dimed I learned that Adam Shepard, a college grad had responded to Ehrenreich's book with his own case study: Trying to make the American Dream happen with only $25 in a randomly chosen city. Starting his journey with a promise that he won't use his contacts, Shepard heads to Charleston, South Carolina. After one year he will be successful if he has a car, a furnished apartment, and $2500 in savings.

A few important approaches Shepard takes in contrast to Ehrenreich: Openness to take advantage of a homeless shelter (not to mention the ease with which he got in), thus putting more money aside for savings. Decent access to public transportation, while Ehrenreich kept her car. Shepard also thinks strategically when contemplating sharing an apartment with another roommate while Ehrenreich never seriously considers this option.

On the one hand I generally agree with Shepard on one point: People should take responsibility for their lives. Be ready to help themselves [Putting aside people with mental illnesses or physical impairments that prohibit them from functioning well on their own day to day.]

On the other hand, I'm well aware of the advantages and supportive backgrounds both Shepard and I have. It's not possible to hide a college education or 12 years of education regardless of saying you will. Significantly Shepard mentions at one point that he had people supporting him throughout his childhood through his early 20s. This likely had an immense positive influence on him that if a person doesn't get as a child, he doesn't get it. And of course, as a single male, a white male who's healthy, possibilities are typically easier, and Shepard admits in part to this. His argument remains that he's still proof that anyone in the US can make it because he did and that hopefully his characteristics (health, race) won't detract from his message. 


Yet if his situation was different (if he had a child, lacked a GED, was a minority) he would be at a disadvantage even as simply as in regards to finding work. Shepard grossly underestimated his advantages. What he does do though, is acknowledge and recommend ways US social systems (i.e. education) should provide support for people of less fortunate backgrounds.

Despite my critiques, I would recommend this book because I enjoyed reading Shepard's journey. His project took strength. I recognize Scratched Beginnings as a book that would be more easily accessible to people in their mid twenties from privileged backgrounds. 

Monday, December 28, 2009

But Tell Me How You're Doing

Harry, an elderly client (who's still waiting to join the social program I had written about) was telling me he gets annoyed at other people asking him about his arm cast. "I go through so many different medical situations," he said, "and people are always asking me about them. I appreciate they're asking but I don't want to go through the whole explanation each time.
 
Putting aside the fact that I was floored by Harry warming up to the idea of other people asking him how he's doing, I told him, "Give them a short answer. You don't even have to be specific. Then then ask them how they're doing. People like to talk about themselves."
 
A week passed and Harry left me a message saying "It worked! Tyrone asked me how I was doing, and I said, 'God bless, but tell me about how you're doing,' and he started telling me all about how he's doing." I was glad it worked.
 
It's not completely accurate though that everyone wants to talk about herself. My dad tells a story of an aunt who would ask him about him, his family, his job, his health, and the moment my dad turned the questions on her she would give him a look of surprised disdain, as if shocked he asked her personal questions. Though she didn't respond, it did stop her stream of questions.

Saturday, December 26, 2009

A Resident Seen Just Once

About half a dozen times in the past three years I made an intake appointment with a resident who didn't show up to the appointment. Once it was a lady who said she knew no one and wanted to get connected with a place like AA ("but not AA" she added), another time it was a gentleman who had just moved to the city and a neighbor told him about us. He was especially interested in our health services. But neither came back.

Occasionally I wonder to myself, what choices did they make? Did they find another agency or place of support? Maybe they ended up relying on themselves. Sometimes I imagine different scenarios of what these folks did and where they are.


It's probably the end of the year that's making me look back and think about choices and paths.

Wednesday, December 23, 2009

Don't Stay for the Clients

A coworker of mine described her job today to someone like this: "I walk along the journey with [my clients]." I loved the idea behind her words. It made me think of an incident that took place around six months ago.

I was riding on the bus with a coworker she turned to me and asked how long I think I would stay at the agency. I answered that I'd want to stick around for a couple more years if possible. I liked the coworkers, the atmosphere, the work. But I chose to start talking about the clients and that I felt they needed me.  "Don't stay for your clients," my coworker said. "Your clients don't need you. They'll be fine without you," she admonished me with a tone that sounded a bit cruel. 


I thought about her words later, and while I agreed with her, I admit it took me several months to truly accept them. Clients would be fine without me as well they absolutely should. Connections have been made and relationships developed but they'll be made again. High turnover is likely not ideal in sensitive situations where vulnerable population is concerned but what's particularly ideal is that folks who come to the case management job do it more than for the sake of having a job, that they're ready to teach, learn, collaborate, be patient, have an open mind. All things that can be learned. Latter is something I try and work on every day.

Also see Hello, I'm Your Case Manager and I'll be Your Superhero Today

Saturday, December 19, 2009

A Public Aid Case Worker Making me Laugh Again

Dear public aid case worker,

If you don't know if client's [medication] is covered through medicaid, would you please tell me who is supposed to know?

---------------------------------------------------------------------------------------------------------
Could you imagine calling your insurance company and being told they don't know whether a specific medication is covered?

????????????????????????

Thursday, December 17, 2009

Trouble with the Phone Line Again

I spoke on the phone today with Martin, an elderly client of mine. I talk to him every few weeks and typically it's extremely hard for me to understand him. This doesn't exclusively happen with Martin. At times clients mumble or it's hard to follow their thought process. With Martin it's a bit of both. Also, his mom was French so sometimes he defaults to French. In short, communication not always easy.

Last Tuesday though I couldn't understand Martin to the point that I told him we'd have to meet in person. I got a word here and there and the tone but that was it. I used my "Must be problems with the phone line" excuse, which is what I say after I ask a client a few times to take a deep breathe and slow down. I felt bad that I couldn't understand him but also frustrated. Cause when the person who's not speaking clearly needs to repeat himself he gets frustrated at you and tends to speak even faster.

Tuesday, December 15, 2009

Clients Calling Me to Refer Friends to Our Program (2)

I really do mean it. I appreciate you're enjoying working with a case manager at our agency. That you're getting enough out of it to want to refer a friend in your building for services. But it doesn't matter how many times you leave me messages about them. It won't move things forward because conversation is still going on between you and me, not the resident and me. If she is interested in services, she knows how to get my number or find the agency.

Maybe a year ago I would have been tempted to get the resident's number from the client and call her but experience has shown me that folks who need us reach out in their time and on their terms. They're also more invested that way.


Also see my first post about clients referring other residents to our program

Sunday, December 13, 2009

Denying a Rental Request -- What Next?

I've previously discussed how my department determines eligibility for rental assistance in its basic terms. We find out why the client(s) got behind and if they have income to sustain themselves should we assist with one month's rent. If the clients don't have an income we can't help them. The reason is that assistance in this case would only be temporary and the client would face the same problem of paying rent the following month.

So what's the next step for these clients? Generally when folks have no income we refer them to our job counseling services. But of course it's not typically a smooth path and not only because job supply is particularly low. Clients may lack experience or skills for many jobs. Referring folks to job counseling also presumes that they're physically and/or mentally able to work and this is not the case for many people we serve in my department. Applying for social security benefits (for reason of disability) is an option but one that in most cases takes at least a year or more.

So let's say a client has no income and is looking for work but not finding one, or applying for disability and waiting. What then? The bottom line is you need an income to stay in an apartment. When we can't help we refer folks to call the city and request short term rental assistance. But the truth is very few organizations have funds to help people with rental assistance when they have no income.

So we suggest people look at their social network. Is there a family member or friend they can stay with temporarily? We also give information on shelters and temporary housing programs (some have waiting lists so clients need to sign up as soon as they can). Occasionally we get word of openings for permanent housing programs for people at risk for/those experiencing homelessness. In such cases it may help to be tied in with an organization that would likely get news when such openings take place.

Sometimes when I tell clients we're not going to be able to help with rental assistance I don't hear from them again even when I offer to continue to work on other options. Some folks who are denied rental assistance come back a year later with new concerns -- they had solved their housing situation on their own. Other times I don't hear back from clients once their in temporary housing. I respect people's choice to figure things out on their own and appreciate the opportunity to be able to work with folks who choose to continue and work with me. I believe that if I was in a similar situation I'd want another person on my side. But I also know the limits of a case manager's role. In the end the client is the one dealing with what's going on. Whether I'm part of her journey is up to her.


How have you as a case manager/social worker dealt with a similar situation?

Note: This post was written based on my personal experiences as a case manager and should not be taken as the rule for every similar case.

Saturday, December 12, 2009

A Few Moments from the Week

A particularly intensive client slipping on the ice. The client was discharged from hospital to return home with order to stay off his feet. He has no family and close friends in the city. See where I'm heading with this?

Finding a bed bug strutting on a sign in sheet during a 'Tenants Rights' presentation.

A second client slipping on the ice and getting blue and black marks on her arm.


Work holiday party (behind me now). 

A third client slipping on the ice and getting a cast on his arm.

Getting only 2-3 pages further in Something Happened.

Tuesday, December 8, 2009

My Work Here is Not Done

A coworker told me yesterday with glee that his (non electronic) inbox was empty. "I'm all done," he smiled, referring to a few large assignments he had finished. I realized he was talking as if he wouldn't get new large assignments again. It took a lot, but I held myself back from commenting obnoxiously about how he'll always have more to do. He seemed too happy. I didn't want to be the one to say that that to-do list is always longer than what he has written down. It's only he may not know about the rest of the to-do items more than 5 minutes in advance. 

Today he told me slightly grudgingly about a new big assignment. He doesn't do case management work exactly, but it made me think of my own work. It helps me think about my work as project based (and ongoing at that). Many times I work with clients on specific goals: Help with finding housing, applying for social security benefits, legal assistance, etc. But ongoing maintenance (for exampe, in dealing with an unexpected crisis) is always needed. Like remodeling a house -- even once it's done you still need to upkeep it. And that doesn't include setbacks involved while building it. 

It helps not to expect my inbox to be empty. Though it's not easy to accept.

Saturday, December 5, 2009

*Cough* *Cough*

Lots of coughers in my immediate surrounding this past week at work. Larger than usual number of folks coughing right in front me without covering their mouths, including clients and staff.

The other day I was talking with an elderly lady during an outreach event and and suddenly she coughed this loud wet cough. Those are the tough ones, the unexpected coughs. I froze for a second and inwardly grimaced. I know she didn't do it on purpose, but -- gah. I could feel her germs invading into my bloodstream. Asking my germs for help in crossing the street.

On another note, it's unfortunate that you can't say something to someone once she has coughed. Saying bless you gets you weird look. There's a few moments of silence as you wait for them to stop coughing. Maybe you offer a drink of water. There should be a word.

Tuesday, December 1, 2009

We Don’t Offer that Service

Except in those few occasions we do. We don’t help you move, but those one-two OK a few clients yeah I suppose we did help them move. Help with getting a new bed? Not really something we help with, except those couple of times last year.
 
It’s difficult to assess some requests (certainly lack of resources like money and time are a component of this). Rental requests are more straightforward: We find out the reason a person got behind. We do a budget to find out if she be able to pay rent on her own after she receives rental assistance. We also look at whether we have helped the client with rental assistance in the past. These types of questions

Other financial or otherwise large requests are discussed case by case. One increasingly common request is help with moving, i.e. physically help. I know a number of clients who would genuinely not have been able to move without external help, if because of mental/physical health conditions, lack of financial support/friends, lack of time. For these clients some staff members were able to fill in that gap in some capacity. But once an exception is made for one client it's harder to say no the next time when a client seems to be in particular high need. Not to mention that each project like this takes time -- while the inbox of other requests continues steadily fills up.

It's true, I'm not talking about tens of clients calling us about help with moving. But considering that helping one person may take from half a day to 2 days of help (in separate blocks of time) even helping 3 folks is a considerable time commitment if you have a caseload of over 40 folks.

Monday, November 30, 2009

'Something Happened' is Testing My Reading Patience

I've been reading Something Happened by Joseph Heller for the past week and I'm a bit torn. On the one hand it reads fairly smoothly. It follows Bob Slocum, an American middle aged man's stream of consciousness. Initially he's thinking about staff at work (who's afraid of who), the women (young women) he has affairs with, then he turns his focus on his family, his wife, daughter, and two sons (and who's afraid of who). It reads authentic to me. A string of uninhibited (as they tend to be) thoughts as he's going about his day.
 

I like that Bob contradicts himself at times, sometimes in the same passage (I do that too sometimes -- though it's also true that at times a characteristic that bothers me). Though I don't easily particularly identify with him, I understand some of the feelings he shares. Dealing with mundane, drudgery routine (what's so wrong with that?). 

A lot of thoughts have been going through his mind these past 430 pages though. So much that I hope I didn't miss anything happening. What's keeping me going is wanting to find out how it's resolved.

Sunday, November 29, 2009

Staff Curiousities

A program manager stopped in my office and held up a public aid application with the top part cut off and asked if I had the complete form. I gave her an extra copy. 

Two days later: I stop by her office and notice her incomplete copy still on her desk. Amused, I  wonder to myself if she's going to keep it as her example of what the incomplete form is when she asks someone else, "Say, do you have the complete application? I'm missing part of it." 

Friday, November 27, 2009

What Do You Do All Day?

Back when I was in college each quarter brought the much anticipated seasonal question: "What'd you do over [fall/winter/and on] break?"

I took on to making up answers to see what I could get away with. Similar to how I deal with weekend questions, I would try to think of a creative activity on the spot. These could include "learned how to camel race" or "interned at a seashell farm." No one needed to know how many hours I spent slouging about.

Similarly, when folks ask me "what do you all day?" once I've said I'm a case manager, sometimes if it's -- or if I gauge it to be -- the right kind of audience I don't go right into my old "no typical day really" but answer it differently. Last example:

"What all social workers do. I don a superhero outfit and fly around with my harp and my fishing rod, handing them out to the community."

 Still want to know what I do? Visit Homelessness Prevention and Emergency Assistance.

Tuesday, November 24, 2009

Past Three Years in a Few Numbers


40-50 folks on my active caseload (number has stayed pretty consistent)

2 clients have passed away

2 clients I've interacted with only while they've been under influence of alcohol*

3 clients have cried in my office

1 time I started crying right after one of these clients left my office

1 time I had to walk out of my office during an appointment with a client because I was about to lose my cool (to the point of shouting back; I asked another case manager to step in)

>25 times residents have left messages asking me to call them but left no number

40 pages: longest fax sent

8 days, (and going) longest period I've spoken with a provider only through our answering machines

3 nights (in the last week) that I had trouble falling asleep because I was thinking about work (typically about specific clients)

More times that I can remember: Clients making me think, making me laugh, challenging me, and making a connection.


* It's the level that I can smell it on their breathe but it's manageable (they stay composed).

Sunday, November 22, 2009

Book Review: If Today Be Sweet

Tehmina, a Parsi woman from India comes to Ohio following her husband's death and upon an invitation from her son to move in with his family. During her stay (not her first in the US) in a suburb of Cleveland, Tehmina is both happy to be with her family and pained at her separation from her home and late husband. Tehmina has a short time to decide whether she wants to stay with her son's family permanently or return to her apartment in India. 

I enjoyed Umrigar's window into Indian culture (here and in Bombay Times). Cross culturally I liked reading Tehmina's comparisons of what she was familiar with in Bombay compared to American customs. Umrigar did a particularly good job developing Tehmina and her son, Sorab's, characters. Both had a good deal of insight into their behavior. Umrigar let them have natural reactions to other characters or developments but gave them a good deal of empathy as well. Sorab's wife, Susan, was less well developed but overall a likeable character. I would've liked to have gone more in her mind, but I appreciate Umrigar's choice not to do this, giving Susan more of an outsider presence.
 
Spoilers ahead:

It seemed that, for Tehmina, whatever life threw at her during If Today she got through it. Not only that, from the halfway point I had to increasingly suspend belief by how everything worked out so well and smoothly. But the characters felt real. And frankly, it feels good to read a heartwarming (in an 'all's well that ends well') book like that every once in a while.

Saturday, November 21, 2009

I'll have my answering machine call your answering machine

My computer works again! In other news...

A few weeks ago a client became homeless.
A coworker recommended me a housing program and gave me Corrie, the intake worker's contact info (I already had an application but saw more info was requested). Last Friday I left her a few messages and finally Tuesday she called me back but I wasn't available so she left me a message. I decided to be more detailed in my message back and asked what info she needed to process my client and later found a message from her asking for my fax number. Got a list requesting over 15 items, from IDs to income info to mental health records to what my client had for breakfast. Some items that I wasn't sure what they referred to. So I left another message following up on them. So far we've been successful in moving the process along somewhat, although of course not as quickly as we could have if we would've caught each other on the phone. In fact, I don't remember the last time I've conversed this long with another provider solely through voice mail.

Wednesday, November 18, 2009

No Computer, No Computer, No Computer

I haven't had a working computer in two days. I just have this box in front of me, screen black, cut off from everything. Some problem with the hardware. Until that's fixed, I'm experiencing a world from the past. The other week my agency actually closed 10 minutes early because computers for all staff needed to be shut down for a network update. As if we can't find anything non-computery to do for 10 minutes.

But so many tasks can't be done. I haven't been able to record case notes and knowing I'm getting behind is honestly distressing me a little (the thought that not 10 years ago coworkers used to record their notes by hand impresses me deeply). I needed to write down my schedule because that too was saved on the computer. Couldn't listen to my CDs. Come on, it's not like I can use some alternate device that plugs into the wall and is capable of playing music.

One good thing is that my interaction with other staff has exponentially increased since I've been fairly frequently dropping by their offices to ask to use their computers. A few minutes here to write a letter on behalf of a client, and a few minutes there to make a quick search in the internet. With a little planning, no one else will be able to work!

Monday, November 16, 2009

Yes, could I reimburse my plane ticket through petty cash?

Message from a client on my answering machine:
"Anatolia! I won $10,000 in sweepstakes! But I have to go to Rome, Italy to get it. I need help to get there and I need someone to go with me. Call me as soon as you get this."

Sunday, November 15, 2009

Verse for a Manager

One visitor to my site, hailing from a country in Southeast Asia, found me by searching for "Verse for manager who's leaving." I wonder what kind of verse they were looking for.

The weight of wallowing projects on his brow,
Her steps are cautious and confident;
The path she leads us seems sometimes unclear,
But at destination I understand.

Two years into my job, I'm so grateful to work with my supervisor, Fiona. She's supportive, she's almost always available at a moment's notice for a word of advice, and I feel very comfortable with her. Sometimes we informally debrief after work hours are done, meaning I step into her office and we talk over how things were. It helps me think out the day out loud.

Though she's amazing in so many ways I sometimes give her a hard time. Mostly I swallow my comments and later share them with my parents or a friend. Working closely with someone for a few years we get to know each others' strengths and weaknesses very well. And weaknesses, well, like a married couple they seem blunt after a few years.

One thing that takes a good deal of patience to deal with is her difficulty in making certain decisions. Small example: Shopping for raffle presents. Fiona could stay at the store for two hours rethinking the pros and cons for each choice. Or sometimes she tells me to do something by saying, "You should do this. Or I could do it. Or [other case manager] could do it." Ba! Just tell me to do it. Though admittedly she's gotten much better about that. I don't want to go into too many examples for sake of anonymity -- but let's keep in mind the number of decisions a program manager needs to make on a daily basis. Times 30, it can get stressful. For her. And for me. That's why I'd like her to actually delegate to me and the other case managers more, but Fiona believes she's part of the team and has to be a part of all programs we do. Which, if the decision was made prior on how a program would go, it's great. If not, discussions abound.

One day I was griping to my parents about something that happened with Fiona and my dad interjected with, "Well, you'll do it differently when you're the supervisor."

"Uh-- Well--" I stumbled with my words. Of course everything's that's not working is painfully clear when you're not in charge. But -- and I have recognized this from the first few months -- Fiona does a lot of managerial duties very well that I don't think I can at this point. But sometimes you just need to vent. Though, ah, maybe less often than I've been doing.

Thursday, November 12, 2009

Beating the Clock

During the past week I've been focusing a lot of energy into a client who's going through a crisis situation. As I've been doing this some of my to-do-tasks get postponed, and slowly build up one on top of another. Though it's not like my entire day is devoted to my crisis client, each day I've been making half a dozen (sometimes lengthy) calls on behalf and to her as well as meeting with her nearly daily. And as I do this, life doesn't stand still for clients who understandably contact me with ongoing concerns or questions.

As I was sitting in my office yesterday, listening to my voicemail and thinking about a new intake I was about to meet with I started hearing the Sorcerer's Apprentice theme in the background. Or in my head. Later I amused myself with an idea of a case manager's video game. This would be in similar concept to restaurant games where you're Yoshi, the shushi cook, or Betty, the cafe cook and you need to cook orders for dine in and to go. Playing the cook, as you complete levels and move up orders come in faster and the dishes are more complicated. Imagine that in a case manager's setting... A case manager sits in her office. Phone rings, a person asks for a food bag. You click on your 'tasks' list for food bag to fill the request. Someone knocks on your door. Rental request. Click on 'rental assistance' to fill request. Coworker stops by and asks for mental health agency info. Click referral. Schedule pops up with "Lead budgeting workshop." Click workshop. 'Appointment' client and 'walk in' client arrive at the same time! Another rental assistance request! Client's hot water isn't working and management won't spray for bed bugs, need to call landlord! E-mail arrives, phone call to get medical records, homevisitmailpaymentmakereferralwalkinclientsitkeepsgoingonandonandon. Oh this would be a hit in no time.

Monday, November 9, 2009

Attending a Client's Funeral

From my seat in the back I had a good view of folks shuffling in and stopping at the casket. I had thought that I would maybe feel self conscious going to Ruth's funeral since I only knew one person there apart from her, but people weren't looking as far back as where I was sitting, but rather were focused on seeking Ruth's immediate family and folks they recognized. I saw people coming mostly as an outsider.

I had spoken with Ruth's brother when I came in and hugged him. It was the first time we met -- we had talked a couple of times before Ruth passed away when she had gone to the hospital.

While I sat in back of the room I thought, little do these folks know. Who I was for Ruth and who she was to me. She was the third client who was assigned to me. She had come through intake asking for rental assistance because she had lost her job due to a mysterious, almost constant pain. She soon found out she had terminal illness. We started working more and more intensively together, coming to the point where we talked nearly daily.

I didn't know Ruth when she was a child or in high school or when she partied or had children.
I only knew her during the time she was in great need. A woman I didn't get to say goodbye to, and deeply regretted it later. I want to describe who she was but don't want to capture her image solely as a person who was in pain. In some ways i don't think I could do her memory justice for knowing her for such a short time. I knew she played the guitar and once saw a photo of her looking very cool strumming on one with her eyes closed. I'm fairly certain pain changed the way she thought, the way she behaved. When I was at the service I felt a little exhausted, a little in shock, pained, and upset that all these people attending the service didn't help Ruth enough while she was alive the way they could have. Later I was able to think about the situation differently, but some things didn't change. I continued to carry her with me.

The funeral is our opportunity, us case managers at my agency, to give clients a last formal recognition and the most final goodbye we can give. I don't remember her as a woman in pain but I remember the connection we made.

Sunday, November 8, 2009

Working and Living in the Same Community

It hasn't happened too many times, maybe around a dozen, that I've spotted clients outside work during the weekend. A couple of times happened in my neighborhood, once four buildings down from where I live. I don't live on the other side of town from where I work so these incidents are not unexpected. But a lot of my clients tend to stay in their neighborhoods. And truthfully when I see clients on the weekend it's a bit odd, like seeing a teacher outside school.

My relationships with clients are fairly well defined at work but don't exist when I'm off duty. More than that, staff is told not to address clients outside the agency unless they approach us first for confidentiality reasons. I understand this but it feels strange not to acknowledge someone you know. Some clients walk past me without saying anything. But others say hello, sometimes waving their hands from the other side of the street. Keisha had been upset at me once, early on when we were working together, when I didn't say hello to her. I explained that I did it to protect her privacy and she said, "No one know you're my case manager!" But I prefer to caution on the confidentiality side.

Wednesday, November 4, 2009

Richard Wright Writings

I can't leave a library without checking out a book or four. It's too hard to resist. Usually when I enjoy a book a lot I go on to read other literature by the author. I just finished Native Son, my second book by Richard Wright. My first was Black Boy.

I didn't want to relate to Native Son's main character, Bigger, after reading the book's sleeve. Bigger's acts of assault* weren't likable nor was he particularly likable, seeming a bully from the first pages. He didn't reflect much on how he treated others nor did he seem to have the ability to analyze his behavior. But I found myself thinking about the layers Wright gave him. Thinking too about the context, the world Bigger was living in, as a black man in segregated, limited (in opportunities) Chicago of the 1930s. Wright didn't excuse Bigger's actions but through him voiced his views on racial injustice. It was a risky choice, to do this through volatile Bigger. It was a powerful read.

The next Wright book I'm tackling is The Ousider.

Monday, November 2, 2009

During an intake

Me, verifying: "Do you have a disability?"
Client: "No, but sometimes my wallet feels disabled."

When I stop and think about all the personal information us staff gathers during an initial appointment with a client it's mind boggling. Sure, some folks answer questions with barely a yes or shake of the head for no and others tell you everything about themselves you ever hoped to know. Most clients share a good deal (we do let clients know that if they don't feel comfortable answering something they don't need to). And we ask quite a few questions, involving health concerns, work history, legal background, and the like. I typically learn a good deal about a new client from our first appointment, and when I ponder this fact I remind myself it can be a lot easier to share oneself with a stranger.

Sometimes my inquisitiveness leads me to ask follow up questions that I don't have to ask. For example, I've had a few female clients answer the education section (what is your highest level of education?) with a number lower than 12. Twice I asked if they felt comfortable telling me why they didn't finish high school, and twice the response was because they got pregnant.

Sunday, November 1, 2009

Just One Buddy

I work closely with Keisha, a client who's been involved in our supportive housing program for over 5 years. I've worked with her since my first month at the agency, around 2 years ago. A lot of the work I do with him is advocacy and referrals. Though we have good rapport I wish I had more of an influence on her in taking part in activities like exercise classes or other community activities (some offered through my agency). She's not involved with other agencies and knows the staff and other clients who come here so trying to bring her to attend our events has been a little (though not consistently) successful in the past.

I can't convince a client to do something she doesn't feel comfortable or interested in doing, of course, and discussions about eating well and stopping smoking (which Keisha and I have had) usually don't make a person make a change. I don't have to go much farther to finding friends and family who choose to continue smoking, for example, and it doesn't matter what others say. On the other hand, Keisha also complains about loneliness and her difficulty in making friends. Years ago she was diagnosed with mental illness. I believe she has a developmental disability as well though paperwork doesn't reflect this.
 
I look at her situation and I think about how it relates to my department's work in trying to create a sense of community at the buildings we provide case management for. We (staff) try to foster this in different ways -- through meet and greets at my agency, occasional social gatherings, workshops. Our goal is for folks to get to know us and each other -- to feel more comfortable with each other. In some cases it means to meet their neighbors for the first time.

And for folks like my client there could be a positive side effect. Making a friend with someone in her building. Someone who would knock on her door to get her out and active. One friend and a sense of companionship would be great for her. Some people find more motivation in exercising, quitting smoking, or just leaving their apartment if they're meeting a friend. But even just for friendship, just support. One person would make a big difference.

Wednesday, October 28, 2009

Comments on Nickel and Dimed: On Not Getting By in America

[For folks who haven't read this book, journalist Barbara Ehrenreich narrates her experience (experiment) working various minimum wage jobs in a few different states in her quest to find out if these jobs are enough to make ends meet]

A friend was looking over my copy of the book and said Ehrenreich preferred to live on her own, a decision that meant that a good deal of her income went towards housing, while having a roommate could've significantly cut her housing costs. Many of Ehrenreich's coworkers, my friend pointed out, shared their housing with other people. Not to mention a shelter option -- something a social worker had recommended at one point to her. Sardonically I replied to my friend her decision not to live with a roommate was offset by the fact she started her experiment with money -- not common for the people working the jobs she took.

Though I have my critiques, I've reread this book many times. A lot of aspects in it appealed to me -- one, a person takes on a new persona. Second, I wanted to explore the story of the people behind these jobs. And of course, though it's strictly anecdotal (based on Ehrenreich's experience) I wanted to know how she got to her conclusion and the process it involved. The process in itself was engaging and Ehrenreich's shared some thoughtful insights. I'd recommend this book not as a bible but a valuable read. Some things I liked was that Ehrenreich succeeded in describing her coworkers' characters in a way that allowed me to relate and empathize with them and put personalities to workers of jobs that aren't typically seen -- maids, waiters, and housekeepers.

Tuesday, October 27, 2009

Let Me Verify That

In the process of filling out a food stamps application with my new client Jeff I asked him how much he had earned at his job in the past month.* Jeff said, "About $200." I asked him if he had his most recent pay stubs and he said he'd get them. We meet again a week later and Jeff said he wasn't able to find his statements. I say, no problem, could I call his company and find out, and he says sure. I call HR, they check, put me on hold, check, and after being transferred from one worker to another, I finally speak with Kayla who says, "Oh, here it is. His last work day was June 5, 2008." You don't say. I ask Kayla to wait for a moment and ask Jeff if that makes sense. Jeff looks at me a bit sheepishly and says, "Yes."

I go about it one more way and ask Jeff if he remembers getting a check for work during the past month and Jeff says no.* Well, now that we got that cleared up, onwards we go.

Sunday, October 25, 2009

Discovering New Sites

I was surfing the internet when I suddenly thought how cool it would be to find a stuntman's -- or woman's -- online journal. Read about his experience doing these cool feats in place of an actor, meeting other actors. The topic didn't seem too eccentric, especially since I keep coming across  journals about every topic under the sun. After several attempts, however, I still came up with nothing relevant. And then I thought, maybe in this case a video journal would be more interesting to follow anyway. Then I started searching any topic that sounded intriguing, figuring that I would likely come across something related to it: From runaways to nurses to hoarders to 20 more topics. I even found a few purposefully fake actors' blogs that were more or less amusing to read. I did find a few relevant sites, some I would return to after my first visit.

I wanted to share one site that isn't a blog but does relate (if only loosely) to my original stuntman search. Called The Editing Room, it's a collection of abridged scripts that, in a nutshell, poke fun at the original films.* Most have been written by Rod Hilton, an aspiring script writer himself. I've been reading this site for over 6 years now and it still continues to periodically be updated with new scripts. I warmly recommend it.

* Site uses some profanity.

Thursday, October 22, 2009

My Client Wanted New Shoes

I have an elderly client who mostly keeps to himself. Though he has a couple of close friends who live out of state and check in on him by phone frequently he seems to enjoy his solitary life. After his friends, his main social contact is with my agency. Both my coworker and I alternate visiting him a few times a month. Each time I've visited him I find him reading something, from a book to a newspaper, once it was a can label. Over the last couple of months he and I had been talking about going shoe shopping, but the shopping trip kept getting postponed -- one time because it looked like it may rain, another because it was too windy, in short, it didn't seem he was ready to follow through once the trip day came. Though this was a bit discouraging I still looked at it as me visiting him and checking in. Last week he asked me "When are we going to go?" and we made an appointment for this morning.

I come in to his apartment today and he's drinking his morning tea. I sit beside him and chat about something or other when he says to me with a huge smile, "Like my new boots?" and lifts his left foot up. Putting aside the embarrassing fact that I didn't even notice that he was wearing new shoes and I was sitting right there beside him for 5 minutes -- he had bought them on his own! I commended him for doing it on his own. I was looking forward to the experience of shoe shopping with him, I admit, but that was real cool. And I'm sure he enjoyed my reaction as well.

Wednesday, October 21, 2009

Hoarding: Background and Link

I was doing some research on hoarding when I came across Obsessive Compulsive Foundation's (OCF) hoarding site. It provides background as well as research articles. What I've written below (not including discussion of A&E's Hoarders) is drawn from this site.

An important aspect in the definition of a hoarder is a person who acquires and doesn't throw away items which appear to be useless or have little value (italics added). Now, while I was researching this topic I initially had a problem with the last part of this definition. Items that appears useless to whom? I'm using my own bias to say I'm not talking about hoarding empty cardboard boxes or 50 copies of one newspaper. Rather, in cases of folks who strictly collect hundreds of books or troll dolls, well, what’s the difference between that and stars who collect items in the hundreds but those items happen to be more commonly accepted as luxurious or rare items? 

There’s another aspect to hoarding, however. And that is that hoarding takes over one's life to such a degree that it interrupts daily life. Items engulf every free space and take over rooms to a degree that it's not possible to use them for their original purposes. Due to stuff taking over, folks aren't able to sleep in their beds anymore or be able to cook in their kitchens. It may cause them to quit their work and stop interacting with other people. Just managing hoarding may consume peoples' days. Significantly, hoarders start to have relationships with their belongings.

Since we’re humans we like to ask why. Where did this behavior come from? A&E's Hoarders’ participants sometimes talked about a family member, often a parent who hoarded. So maybe modeling took part in it for some folks. However, many children of hoarders don't necessarily hoard themselves. a person going through deprivation is not more likely to hoard.

In A&E's second episode, the psychologist talked about the significance of the hoarder to be the one who goes through her belongings and makes the decision of what to throw away. Just throwing away everything is traumatic and doesn't solve the problem. Hopefully through the process of discard and decision making a person is able to improve these skills. As seen on the show, though, this process is painfully arduous.

A hoarder has little intrinsic reason to change his hoarding behavior. Usually it's an outside influence, like a spouse threating to leave or eviction that causes a person to want to take action. In case of eviction a client may be under a tight time constraint to clean out his apartment. So, as case manager advocating for a client, what should happen? From my experience I would argue that if a person faces eviction it's more important to do what I can to make the process go faster and make sure my client understand that she's in danger of losing her housing if she doesn't take action. Truthfully, though, my one experience with hoarding was fairly easy to tackle compared to most of the situations I saw on Hoarders. One reason was because it was a studio apartment but another was that the client I worked with was open and very cooperative. That made a huge difference.

Tuesday, October 20, 2009

I Know I've Been at the Office Too Long When

I try and record every contact relating to a client (either directly or on behalf of) right after the interaction. Staff has to record every contact. Sometimes after finishing a conversation with a coworker about something completely casual like her vacation, I find myself instinctively thinking, "I should log this contact." Some days this happens more than once a day.

Sunshine is only a nickname a client calls me by.

When someone mentions plants I think of bamboos.

Calling my landlord I say: "Hi, this is Anatolia from [agency]."

Sunday, October 18, 2009

Gwen Thompson, the Doll Experiencing Homelessness

American Girl recently released a new doll, Gwen Thompson (source and source). Though American Girl has been around since 1986 I didn't know much about this company. So I didn't know that each new doll is accompanied by a paperback that teaches kiddies a little something (standing up to bullies, experiences of a Jewish girl to Russian immigrants, and so on). I wasn't able to read Gwen's full story, but one repeated fact was that she and her mom became homeless after Gwen's dad left home. Gwen sells for $95.

I thought a lot about this, how it glorified homelessness, specifically in the fact the doll was so expensive and it was possible to get her accessories but didn't seem to deal with the meat of her story. Admittedly, I haven't read her actual story but from AG's press statement it looked like the focus of Gwen's story was elsewhere.

American Girl issued a press statement reaffirming that Gwen is part of its 2009 Girl series that focuses on bullying. The statement didn't reflect on Gwen's homelessness experience, but AG did reaffirm its fundraising relationship with HomeAid America. None of Gwen's sales go towards homelessness prevention.

On the other hand, I thought, AG will continue to sell dolls, why not have a doll with this particular backstory? Maybe it will open a few minds. Aren't books a great way to do this -- and in this case they're sold as part of a package alongside the doll. But in the end, despite any possible good intentions, it ends up as another piece of consumerism that seems more superficial than anything else.

One statement that struck me as thought provoking (though I don't think I read it the way it was intended) was, in reading feedback on Gwen on AG's site, one mom wrote "Gwen didn't come with much" and went on to write the clothing she bought her. Another doll to buy and accessorize.

Thursday, October 15, 2009

Dealing with Walk Ins

I'm finally getting used to accepting walk ins as part of my day -- and without it meaning that I see every walk in right away. Thankfully most of my clients don't do this often -- often being once a week (emergencies notwithstanding of course).

Walk ins come in two groups: Folks who stop by to make an appointment, and folks who want to be seen right away. Some of the time clients who want to be seen right away have an emergency situation a la "my heat is off" or "I got locked out of my apartment." Types of situations that require immediate (or day of) attention. Most walk ins, though, are more mundane. A few examples are asking for a bus card to travel and see the doctor, asking to use the phone, or understand what on earth a social security letter is rattling on about.

Here's the thing. It's pretty unusual to be seen right away in most agencies. I can't think of too many times I can walk into an office without an appointment and be seen right away. And sure, not all case managers, for various reasons, are able to see clients immediately but some do. Being seen right away doesn't necessarily mean to meet with the client in my office, but rather meet with the client in the lobby to find out why she has stopped by.

I do understand that for some clients who don't have a phone (or have ran out of minutes on a cellphone), it's not easy to call and make an appointment. And of course not all clients expect to be seen right away. But those who do are sometimes quite perturbed, as if finding out that they aren't the only client on my caseload. Which is when I get a look to the effect of "What do you mean, but I'm here now!"

My problem was initially that while I was concentrating on something or meeting with another client it would throw me off to get a call from reception that a client was in the lobby asking for me. A regular phone call goes to voice mail, but a a client's physical presence means it's a situation to be dealt with immediately in some way. In my first months especially I would think, well, the client made the effort to come here, I should just go downstairs and talk to him. I also thought that it may be urgent if he had walked from his apartment to see me. But then I learned this wasn't usually the case (and if it was an emergency reception would tell me).

Now when I get a call I try to give a specific time that I can see the client. Some clients accept the appointment time; some want to negotiate the time through our receptionist and to his annoyance; and some I know I would likely need to go to the lobby and talk to because that's just how it is. It's the deciding-right-away-on-a-plan-of-action that may seem straightforward but to me took time to learn. I see it similar to learning a dance.

I've gotten better used to accepting walk ins as part of the flow of the day. But I was never such a great dancer.

Tuesday, October 13, 2009

Recognition


I'm flattered to be nominated the Over the Top award by Ash at Be The Change. I myself have been a reader of her site for some time and enjoy reading her thoughts and insights as she leads an ever busy schedule -- read more at her site.

The award comes along with a few rules that include answering a short questionnaire with one word answers and nominating 6 favorite blogs. I'm putting off the questionnaire for now but I did want to give recognition to 6 favorite online journals of mine. Six is not enough to include all the journals I faithfully follow but respecting this limit I would include:

Oregonamy1972
Eyes Opened Wider
Fighting Monsters
CJ Social Worker
Awake and Dreaming
Socialworksblog.info (because 6 really isn't enough. Also, I want to give another plug to this great resource for social work blogs, both on the site and through other folks' links. I've discovered great reads here)

My plan is to continue to link (through my posts) to journals/posts that I find thought provoking or entertaining. This will take some time.

Sunday, October 11, 2009

Book Review: Learning Joy from Dogs without Collars

Learning Joy from Dogs without Collars is Lauralee Summer's memoir of growing up while experiencing homelessness. Reading its sleeve I misconstrued its intention and thought she would describe it as an idealized upbringing. I got ready to read it with an open mind and expected it to challenge my views on what a healthy environment is for a child -- specifically experiencing instability in terms of not living in a physical home, a constant and safe place to come home to each day. I read it also to explore a world that is in large part foreign to me though I've worked with families in similar situations.

Summer doesn't paint the ideal life that I had inadvertently expected. Her mom was the sole provider and parent in her childhood, though Summer also talks about an important role a teacher played in her life.* Summer and her mom moved frequently (20 times before Summer turned 12) covering four states.

What drew public attention to Summer's story was the fact she overcame homelessness and attended Harvard ("Homeless to Harvard"). Cue the "Oh see, if she was homeless as a child and went on to attend a prestigious school then why don't--" Yet Summer chides the reader not to take too far this accomplishment. She notes her mom's support and love as well as encouragement to learn. Summer consumed books as a child which seemed to give her a head start for school in early years. Though Summer's relationship with her mom was described as tumultuous at times it seemed she was also a rock for Summers – importantly, at one point she confesses to thinking of home as a person, not a house.

Summer's vivid storytelling and sober insights made this a great read. It certainly challenged me. Learning Joy brings to light the reality of families experiencing homelessness and, though maybe not explicitly, reinforces the idea of how easy it may be to become homeless. If a family becomes homeless, what should a parent or guardian do? Keep the child or give the child to another person who may provide better? I raise this question since for some period Summer stayed with a foster home and relished the stability that gave her (interestingly, another girl at the house hated the home's rules). I tried to relate it to me. If all other variables were true the same and my parents loved me the way they did, would I prefer to live with strangers rather than my parents, though it meant staying at a shelter? No. (Important to note to that in reality family experiencing homelessness would likely change a lot of the variables around) Would it be healthier for me to live in a more stable life? In many ways, though a foster home would not necessarily be a guarantee for it.

As always, I'm a fan of books that make me think.

* Summer eventually reconnects with her father her sophomore year at college.

For more book reviews, go here.

Thursday, October 8, 2009

"Do Your Programs Later in the Month"

We have a monthly program that's along the lines of an open mic night. When we started it was well attended but over the last year numbers have been down. We have our regulars, but usually no more than 6 clients. A few days ago a client took me aside and said, "You know, this isn't my place, but I wanted to suggest that you have these events later in the month. In the first week everyone gets (government checks) and they're off spending them. That's why you have so few people."

Great point, I told her, and said I'd pass her advice on. It makes a lot of sense. Sometimes it's hard to change the scheduling of an ongoing event once its dates and times have been established (meaning there may be resistance on staff), but I think it's worth changing and seeing if attendance increases.

Wednesday, October 7, 2009

Exercising Free Will to Sign Up for Case Management Services

"I told my friend/daughter/grandma about your program and I want to sign her up for services." Don't get me wrong, I love when folks in our 6 buildings spread the word about our supportive housing program and tell them they could get a case manager at my agency. But usually when an established client calls on behalf of another person to sign her up for services the other person doesn't follow through. I'm not necessarily doubting the sincerity in my callers or their friends' interest in the program. But after a few no shows (when I had relented and set up an appointment for the new person without having talked to him) I started redirecting callers to have their referral person call me directly.

A more extreme case happened to my coworker. Apparently someone had brought in a resident (over 18) and told her, "Here, these people can help you" and left. When the lady met with my coworker to do an intake she refused to give any information beyond her name, birthdate, and address. I'm presuming some mental health issues were at work from the way my coworker described their interaction. For example, after the third time my coworker explained what services our department provided the client looked around her and asked, "so what is it you all do?"

Situations like this make me see the advantages in the fact that folks living in the buildings we serve people aren't required to sign up for our program (specifically case management services) so they come of their own free will. Though we focus some energy in drawing new folks in.

Tuesday, October 6, 2009

Moments When it Feels Good to be a Case Manager

Note: I work in a supportive housing program. Our main goal is homelessness prevention. Compared to other departments at the agency my program tends to work with clients on a long term basis (sometimes over a period of several years). Read more about it here.

It's a good feeling to see clients come back. When they make their appointments -- services are free so they have no fine to pay if they miss an appointment. That they return because they find meeting and collaborating with me helpful to them in some way. Of course a few come back with specific requests along the line of busfare or gift cards, but not all do.

And of course, though I try not to expect it (admittedly this is hard), it also feels good to hear thank you -- makes me be even more sensitive to tell others thank you and be appreciative to folks who work with the public, customer service, and the like.

It's great to know I can joke around with a couple of clients who initially looked at me with not much more than disdain.

That moment that I know there's a connection, that rapport has been established -- it's rewarding as well as at times a relief. A connection meaning that there's an understanding there. I may have mentioned before that I knew a case manager who had the knack of creating rapport quickly, sometimes during intake appointments. I sat in on a few sessions with her and was in awe at her ability to do it. For me it seemed to take longer, but it's rewarding when it happens.

Not to mention it's cool when new folks come in and ask to become a client and I ask them what brought them to the agency and they say "I heard about this place and I just wanted to hear what kind of programs you have. I want to get involved."

Sunday, October 4, 2009

Healthy Level of Insanity at Work

This is a classic list that I can't take credit for -- nor am I sure who's the original source. Regardless, I could read it hundreds of times and still laugh. Co titled: Fun things to do at the office to the amusement of your coworkers:

1. Page yourself over the intercom. (Don't disguise your voice)
2. Make up nicknames for all your coworkers and refer to them only by these names. "That's a good point, Sparky". "I'm going to have to disagree with you there, Cha Cha."
3. Send email to the rest of the company telling them what you're doing. For example "If anyone needs me, I'll be in the bathroom."
4. While sitting at your desk, soak your fingers in "Palmolive."
5. Put mosquito netting around your cubicle. Play a tape of jungle sounds all day.
6. Put a chair facing a printer, sit there all day and tell people you're waiting for your document.
7. Arrive at a meeting late, say you're sorry, but you didn't have time for lunch, and you're going to be nibbling during the meeting. During the meeting eat 5 entire raw potatoes.
8. Every time someone asks you to do something, ask him or her if they want fries with that.
9. Send email to yourself engaging yourself in an intelligent debate about the direction of one of your company's products. Forward the e-mail to a co-worker and ask her to settle the disagreement.
10. Encourage your colleagues to join you in a little synchronized chair dancing.
11. Put your garbage can on your desk. Label it "IN."
12. Develop an unnatural fear of staplers.
13. Send e-mail messages saying free pizza, free donuts etc... in the lunchroom, when people complain that there was none... Just lean back, pat your stomach, and say, "Oh you've got to be faster than that."
15. Reply to everything someone says with, "That's what you think."
16. Adjust the tint on your monitor so that the brightness level lights up the entire working area. Insist to others that you like it that way.
17. As often as possible, skip rather than walk.
18. Five days in advance, tell your coworkers you can't attend their party because you're not in the mood.

I laughed when I first read the list and saw that something I do is actually on there -- namely calling some coworkers by random nicknames. I would probably try some of these for laughs -- which may say something about my weirdness. Seeing other peoples' blank stares of disbelief is entertaining by itself because of my tendency to seem serious at work.

Saturday, October 3, 2009

Comparing Client's Financial Choice with My Own

I had a client in my office who was talking about difficulties in making ends meet, especially considering around half his income goes to rent. During our conversation he mentioned going shopping and getting pants for $30. Then he said he spends about $75 on clothes every month. Since I know this client I knows he sometimes spends money on things he want before things he needs -- meaning occasionally not paying his rent in full (to the annoyance of his landlord), choosing instead to get something he wants (DVDs, eating out at restaurants, and so on). I asked if he sometimes buys clothes at thrift stores. "Second hand clothes?" He shook his head, "No I don't like getting used clothes," and I thought to myself, "Hey if it's good enough for me..."

We all compromise in things we want. I will probably not be able to get the car I want. However, I know I have a lot more freedom in options of purchase compared to most of my clients because of sheer difference in income. I actually understand there are lines people don't want to cross -- I have a friend who won't buy used books. Yet it seems the logical choice: With less income choices need to be more thrifty. On the other hand, with less income and less opportunities to entertain yourself every little bit goes a really long way. Doing anything, though, that jeopardizes your housing (by not paying rent first when you get your check) is harder for me to understand.

Thursday, October 1, 2009

Post Bell Jar Thoughts

I did move on to a lighter book since Bell Jar but some of it stayed with me. Plath's writing made me think a lot about what it's like to look inside a mind of a person who has mental illness. I'm not a clinician -- my knowledge about mental illness comes from college classes, reading, and of course, the media.

Reading Bell Jar was hard for me because I sometimes empathize so much with the protagonist that I almost feel like I'm going through what she's experiencing. After finishing it I caught myself thinking about how she was feeling so much that a thought crossed my mind -- could thinking about it like this make me become mentally ill -- slightly similar to how med students start thinking they have the illnesses they're studying.

The fact Esther didn't go through a particular event that made caused her to start the path to a mental breakdown was eerie but made it easier to relate to her. From a state of 'normalcy' -- whatever this is -- to imbalance. This got me thinking about the fact many of us have mental health issues but some are able to mask them better (or deal with them more effectively). I contemplated the definition of a normal (mentally healthy), or a well adjusted person, in societal terms. Is it the ability to have a long term relationship? Hold a job? After all, in the US the definition of disability is inability to work for one year or more. So are we mentally 'normal' as long as we can work?

Also see Book Review: Bell Jar

Tuesday, September 29, 2009

Not Medicaid's Phone Number, Please!

Coworkers, there's a reason I'm emailing you my question about Medicaid instead of trying to get a hold of someone at the Medicaid office! It's because I'm not a masochist! I already have the Medicaid office number -- yes, and the supervisors' numbers.

When I was writing the email to staff the original text included a line about "please don't give me Medicaid phone numbers." I decided it read too obnoxious. After getting half a dozen suggestions to call various 1 800 numbers and supervisors I started feeling a hint of regret.

Actually it's quite fascinating how Medicaid has all these different contact numbers. It's like trying to enter a magical castle and you see 100 doors before you but only one takes you inside. The adventures the others take you on are considerably less thrilling.

Monday, September 28, 2009

Male Volunteers are Hard to Come By

"Why should I join this for?" My client grumphed at me when I told him about a social program I thought he may benefit from. "I don't like people!" He added. But I had known Harry for several months and observed that underneath his grumphness he sought out social connections with people. He had tried adult daycare* before but didn't stick with it. Eventually Harry approached me and said he wanted in. That was eight months ago -- Harry's still on the waiting list to join the program. The program matches clients and volunteers on a one-on-one basis and only folks of the same sex are matched. There just aren't enough male volunteers. It's not like there's an overflow of women volunteers, but the female/male ratio is heavily skewed and men are readily sought after.

I asked a coworker what he thought about this male shortage. In his (arguably nonscientific) view most guys don't take the extra step. They care, but don't do something about it like women do. I started thinking about what would make it easier for a guy to volunteer. One of the times I had checked in with the program worker to find out Harvey's status (still waiting -- really I was making sure we didn't slip through the cracks) she was bemoaning the fact that potential guy volunteers pick up applications but rarely mail them back. Would it help to meet these potential volunteers at a place near them to fill it out? Or set up booths in colleges and have students sit with a program rep and have them fill them out the apps on the spot?


* Daycare, really? Couldn't they choose a more appealing sounding program title?

Update (2/2/10) My client got word today that a volunteer is available! A meeting is going to be set up in the end of this week for them to meet for the first time (along with program coordinator and myself). Here's hoping it works out.

Friday, September 25, 2009

Singing about Sleeping. Brilliant.

I was lying in bed listening to a truck drive in reverse for five minutes, slowly edging into a wake up state when I thought how cool would it be to write a song about how tired I was just like John Lennon did (I'm So Tired) and have it be incredibly famous. About something as inane as how tired I was feeling. May be an inane feeling, but it takes talent to write a song out of that feeling that ends up being impressed on other peoples' minds. That's such a cool skill to have, to be able to write music.

I've written before that though it has been long since the Beatles have recorded together (while all members were alive that is) and many bands have since then made music I'm still pretty loyal to them. I don't think they're the end all of music, but I could probably listen to them every day and not get bored. Another thing: Since I like them so much I'm also more open to songs of theirs that are different. Take Revolution 9 from the White album. I would likely had never given that song a chance if it hadn’t been recorded by the Beatles. Maybe I would have if it was performed by another band I like -- maybe. And though I can't say I enjoyed it after listening to it for a few times, I had to commend the band for experimenting like that. But would I be as quick to hail another band for doing the same experimentation? Probably not. It makes me think about what point songs become popular because of the musician (say, when a musician has established herself enough). It's true critically acclaimed musicians aren't promised to never receive bad reviews for new music -- if they banged on pots and kept a beat by clapping lettuce leaves together they wouldn't be taken seriously. But maybe they would. Or at least catch a break.

Thursday, September 24, 2009

Coworkers I’ll Miss

In the two years that I've been at my agency 20 of the 30 original staff members (for me of course) have changed. Some positions have seen a turnover of two or three workers. Sometimes it was easier to say goodbye. Not much chemistry and all that. Less easy to work with. Other times it was a real bummer. Such was the case when two close coworkers -- friends really -- left around two months ago.

Yeah, yeah, two months is a long time, but while I don't gaze at their photos on my office desk all day, I do feel a difference. Even though overall I like my coworkers and I'm grateful that virtually everyone on staff is supportive and warm. I can almost always wander into someone's office with a question and have that person be ready to stop what he's doing and listen. But it’s not like having my buddies around. The people I could vent to or use humor in ways I can't with other coworkers. Initially after they left it got a little easier to want to hide in my office during lunch with my book and my CDs.

It's incredible how having a couple of people, even one person in your office as someone to confide in, laugh with, or grumble with is therapeutic.

Wednesday, September 23, 2009

For Your Social Work Blogs Fix, Go Here: Socialworkblogs.info

I follow a lot of social worker online journals. Many of them are updated through this fantastic website: socialworkblogs.info. The breadth of specialties is broad, including in part hospital, hospice, prison, and foster care social workers, to students of social work. Periodically new blogs are added. I warmly recommend this site for folks in the field as well as folks who aren't; It's a great window into what social workers do and their insights (as well as news updates relating to social work and links to other social work blogs -- there are always more to find).

Monday, September 21, 2009

Clients Leading Workshops Independently

I had lunch outside my office today with Ann, a friend of mine and a case manager at another agency. Lauren, her coworker, hung out with us too. Shockingly we didn't talk about work the entire hour, but while we did Ann told me that there was some debate in her agency. It centered on whether it was appropriate to have clients teach budgeting classes on their own (specifically under the umbrella of her agency). In the past case managers typically taught budgeting classes (usually an hour and a half session) but Ann was trying to push for graduates of her budgeting class to teach it on their own. She didn't want to stop leading classes but wanted to introduce the idea that on occasion clients teach the workshop independently.

A few of Ann's coworkers, including Lauren, disagreed that it was appropriate for a client to be the only teacher and compromised that a case manager should co-teach the class alongside the client. Lauren said that while some clients know a lot about budgeting case managers had more training and experience (most case managers who taught the class were trained on the topic, but some were not).

I was a bit torn on this though I sided more with the idea of clients leading budgeting workshops on their own (though with a presence of a case manager). I myself had taught a couple of budgeting classes and had a mix of students -- clients who seriously mismanaged their money and others who had it down. [At this point I'd like to note that class structure was based a good deal on discussion and every participant shared valuable insights -- of course I have to add this social worker qualifier]. Ann argued she would only approach specific students who excelled in her class to teach.

A lot of what she said made sense. After all, aren't clients who have their financial management down also the best teachers since they share common challenges? In return to feeling they could relate to a client-teacher better, clients may respond better to the material. On the other hand, I understood an agency's hesitation to put it all on clients' shoulders. It wasn't necessarily the question of clients' ability to teach the class as much as teaching while representing the agency (as case managers do when they run workshops).

Interestingly, we've had a precedent at my agency of a client leading a workshop. A few months ago a client ran an art workshop that encouraged clients to express themselves through drawing, painting, cartooning, and so on. It was very successful and well received. As I pondered a client teaching a budgeting workshop in Ann's agency I thought back to this example. I had no problem with the idea of a client teaching art. Is it less threatening to have a client teach certain workshops because there's no threat they'll "get it wrong?" This based on an assumption that some topics will have a more serious fallback if not executed "right"?

Saturday, September 19, 2009

Measuring Success with Clients

I've talked about how my program measures success by measuring the number of clients who remain housed at the end of the year. In addition to this measure I qualify my success with clients on a separate plane – and how I assess success with clients now differs from how I did it during my first months as a case manager.

Initially I equaled success with my client’s ability to become more self sufficient and empowered. I assessed this through client involvement in self improvement workshops (like budgeting, health related topics) on one level. On the other, I aimed to encourage my clients to find work if not or become involved in their communities through volunteer work. It would be enough for a client (who had a disability, either SSI/SSDI) to mention casually that he was thinking about working for me to think that with enough positive encouragement he would feel ready to return to work and do it by getting involved in our job counseling program.

Two things were at work here. One, my background and ability to work biased me when it came to assessing other folks’ ability to work. It was very difficult for me to fully comprehend the challenges people faced while looking for work, whether they had a disability (SSI or SSDI) or not. [I should note that this was around 2 years ago, when US economy perhaps wasn’t booming but not facing the crisis of the past year]. I was able recognize those folks on my caseload who had serious ailments that prevented them from physically or mentally being able to work. But for others I overestimated their ability to do so. Or maybe I had too much of a grand view on how easy it would be.

I remember trying to persuade one client to join our job counseling services. This was a gentleman who had worked but became disabled for mental health reasons. He complained about his income and I suggested that maybe he find a part time job. He told me he wanted to work but that he couldn't come to job training orientation days because he had to take his medication. I said that he could take it at home or take it at the office. He just repeated that he has a process and a specific time to take his medication and that he doesn't want to do anything that would get in the way of that. Eventually he said he would go to job counseling but then didn't come. Again he told me that he didn't want to go because his medication regiment. I was quite frustrated with this because I saw it as something so simple to solve. Later I thought about it more and tried to understand that this man was in his mid-40s, who hadn’t worked in over 5 years and was living with a partner who had her own physical ailments. And of course he was dealing with a mental illness.

I set my goals differently now. I have more realistic expectations. It’s not going to be a simple formula by which all my clients go back to work. I continue to encourage empowerment by recommending workshops to clients and through running various presentations for the community. This is something I haven’t changed. But through working with clients I learned that many weren’t aware of their rights – or obligations (in regards to public aid, health benefits and so on) and knew this was an important baseline that needed to be established. And that’s an important step to empowerment. And importantly, I do my best to adjust myself to a client’s pace and interest in what she wants to do.

Wednesday, September 16, 2009

Client Runs Away from Nursing Home and Elopes

"Debbie has escaped from her nursing home and eloped. The home's staff doesn't know where she is," read the email from my supervisor. Debbie's a longtime client at my agency, and was tied in several programs over the past ten years. She hadn't had a case manager at my agency for at least five years, around the time she moved to a nursing home (due to mental illness). She was in her early sixties at that time. Despite this she still came by the agency for social events and kept in touch with a few staff members who checked in with her occasionally. Even those who didn't work with her knew her by name. I spoke with her a few times and thought she was very sweet. She taught for 25 years and still seemed to have a demeanor of a teacher.

Reading the e-mail I was surprised at first and then couldn't help but think -- that's sweet. I'm not a big sentimentalist but I couldn't help romanticize the scene. Debbie and her boyfriend leaving together and taking a bus towards the sunset. I had seen Debbie and Ben, her boyfriend, a couple of times and all of staff had heard of him. They moved into the nursing home around the same time. Neither one had family that we knew of and when the two would come to an event together they would sit in the back and hold hands. Usually Ben would fall asleep at some point. No one on staff had heard of Debbie's plans. The nursing home is understandably trying to locate them and truthfully I expect they would come back in a few days. But I want to think they get a day of honeymooning first.

Tuesday, September 15, 2009

There's a Sport for Everyone -- Fighting Burnout

I had a much overdue realization of an easy way to let stress out. An easy way that I successfully resisted for a long time being the avid non-exerciser I've tended to be since... uh some time. I blame high school phys ed, with their dreaded theme classes, the one mile runs to baseball classes. And climbing up ropes, I was just no good at that. I'm pretty competitive and when I know there's something (usually meaning a game) that I have little chance of winning, I tend to want to have little to do with it. Also I'm pretty lazy. In the bell of 'sportive stamina' I'm somewhere on the lower end.I know this is something not to be particularly proud of with everyone around me doing yoga, playing rugby, jogging, walking and all of that. However, though I wasn't proud of it I was pretty comfortable with it. Every once in a while inspiration of getting in shape grabbed me, and I would take a friend and go dancing.

A week ago my friend invited me to play tennis after her usual partner wasn't able to make it. As we were getting ready to play I thought everything was going great until she told me I needed to stand on the other side of the net. OK so that much I did know, but it was the first time I tried playing tennis. Then we started, not playing competitively, just passing the ball to one another. It felt great. I felt alive. I could serve OK but got a real workout chasing after the ball. Getting back home I was thinking to myself this will be a burnout antidote.

Also see Ways to Keep Sane as a Case Manager

Monday, September 14, 2009

Yellow Note Tales

Despite the annoyance of getting them done, I do of course enjoy the fact that white and yellow case notes document every contact with a client for the sake of not having to rely on a faulty memory. Also, it's a good way to learn what other case managers have worked on with clients before they were getting transferred to me. White notes are cut and dry. Factual information: purpose of contact, service provided, plans to move forward. What, who, when, where, and to a degree why of social work. Yellow notes are for everything else, that is, what's not factual. I sometimes also document secondary services in yellow case notes. Also documented in yellow case notes are what the case manager thinks and/or her impressions of client's mood, unusual behavior by client, quotes, and so on. The juicy stuff.

Over the years and across departments case managers have seen a lot. In one incident a case manager returned to her office after making photocopies for a client and caught him take a swig from a flask. Clients have been seen at various points of undress while answering their door.

One incident involved A separate file revealed a client wanting to file a complaint against his case manager. The case manager had visited the client and his wife's apartment after having not heard from them in several months (we do follow ups if we haven't heard from a client in a while). The wife had spoken curtly to the case manager and slammed the door in his face. The client complained that the case manager had tried to hit on his wife, resulting in him asking to see another case manager and finally transferring out of the agency.

And another incident made me pause: A case manager was at a bank with a client to open a new account and set up billing payments for him when a few muffled bangs were heard. Not knowing what he was hearing at first, the case manager froze for a moment until he saw other people bending down and the client with him shouting at him, "Duck!" It turned out a shooting took place a block down the street. Not being close to it, the case manager didn't see anything. After eventually leaving the bank the case manager asked the client how he was feeling. "It had to happen on a Wednesday," the client answered him and shook his head.

Saturday, September 12, 2009

Book Review: Bell Jar

A friend recommended this book to me. It's the first time I read Sylvia Plath.

When I read the short snippet of The Bell Jar on the back cover it made me a bit nervous because it seemed very heavy. A protagonist goes through a mental breakdown and it's semi autobiographical. Didn't I suggest staying away from too much heaviness outside work for case managers? I believe I did. I knew that at times just coming back from work I felt emotionally exhausted. So I hesitated to read it. But I had to read the first page and from there pages flowed and I couldn't stop.

Esther Greenwood is interning for a magazine in New York with a group of other young women and though she feels a bit out of place because she comes from a suburb in Boston and doesn't come from a wealthy family she makes friends and seems to take in the experience of New York. She's on a summer break from university and has a lot of possibilities ahead of her (though this will later haunt her). As the internship continues her mental health slowly becomes more and more unstable. It's not that one experience drives this. Interestingly, the reason behind her breakdown doesn't seem to be focused on. Rather, Plath takes us down the path of what a person feels like as it's happening and it felt authentic to me. I empathized with Esther, though she was quite self centered and self focused for nearly the entire book. Despite this she was a likable protagonist. I also shared some thoughts she brought up. Like the fact that even though so many opportunities stood before her, taking one would mean that all the others would darken. That seemed to overwhelm her.

This book made me think a lot which I love. It was also just like I anticipated, a heavy read. My next book will need to be lighter. The Bell Jar makes the line between sanity and insanity seem like a thread. And of course the two aren’t firm blocks standing side by side marked by a clear fence, nor is the distance between them necessarily vast. My job has also made me think about this.

Wednesday, September 9, 2009

Dealing with Irate Clients

"So you which way do you think got this done (getting electricity turned back on), your way or my way with writing letters?" My client asks me and I hear the anger in her voice.

I almost shrug to convey it didn't matter if it was my making calls on her behalf or my client's 10-page letters to the electric company. "Whichever way it was, it worked." My client immediately relaxes and smiles.

I admire people who are able to diffuse tense situations and deal with angry people effectively. This situation wasn't extreme -- my client wasn't angry beyond control but I knew her and detected the edge in her voice that in the past has sometimes led to a much angrier state. I was able to diffuse her anger but I see case managers who seem to be naturally adept at this.

My experience of taking a Crisis Prevention class reinforced to me the logical rule that every stage of anger (and in my opinion, each client) takes a different approach from a case manager. During early stages it's still possible to use rationality. If I see a client's annoyed, depending on the situation, I try to assess why she's upset and what can be done at that moment. to change her mood. Does she just want to vent, does she want something specific to happen? Is it possible to have it done? Is it something as simple as changing the subject to a more pleasing topic? Ability to think quick helps here and this is something I continue to work on. It alsousually helps to know the client because you know more easily what calms her or him down.

I remember another case manager walking down the hall with a client who was bawling, this deep cry like a wounded animal. Fifteen minutes later the case manager passed again with the client, talking assuredly at her and the client nodding back, her body language softened.I later asked my coworker what she did to calm her client down. My coworker said she told her client to take a deep breathe, then asked her what's the first thing she needs to do. So simple.

More difficult are times when there's just nothing that can be done at that particular moment to calm a client down. Like in situations when a person hasn't taken his psych medication or that he's so angry he's beyond the stage of rationality. I've had clients go off on me angrily without me knowing what triggered them. Rarely have I had to leave the situation because it became too tense and I had to ask another case manager to intervene. On other occasions, I've also had a client that would always grimace at me like she was tasting a particularly sour glass of lemonade, but a joke or even silly attempt of humor was enough to establish a connection.

I also didn't touch on the distinction between situations when a client is angry and a client is angry at you, the case manager. But that's for another post.

Tuesday, September 8, 2009

Waiting for Dr, Thoughts Come Up

I was sitting waiting around to see my doctor, going over my questions to him in my head, and looking around the lobby to see most of the people waiting alone. I found myself thinking, man, wouldn't it be great to have some sort of Doctor Visit Buddy System. It's the kind of idea that if this works and this works and this works then the potential is great. People scheduled to see a doctor would be able to opt to pair up with another person to do this. The idea behind this is that those folks who aren't married, have a guardian, a caretaker or a case manager to go with them to doctor visits would have an alternative -- should they want it of course. Clearly the reason I thought about this was because ideally it would make me feel more comfortable. For one thing, having another person with me would make it easier to make sure all the questions I want asked get asked. Another person may think of questions I don't think of.

People would join this pool of volunteers just like there are networks for couch surfers, Craigslist and the like. I know the whole confidentiality issue may be a concern for sticklers. But similar to other networks volunteers would be evaluated based on others' experience. Anyway, way I see it some folks are more likely to discuss certain health conditions/ailments anyway, why not make it a social event? People go online and meet with others on forums all the time to discuss their health.

It's fun to have your mind wander sometimes.