Tuesday, June 30, 2009

Thinking on Your Toes and Faking it

I admire other case managers’ (and social workers) ability to respond quickly and effectively to a completely new situation. This is something I'm continuing to work on. It’s refreshing to constantly deal with new situations because I’m always learning. Not only that, but it’s also outside of my comfort zone, which is just what I need. I like it when I can follow a certain procedure. Need to apply or reapply for food stamps, I’ll help you with that. Need legal guidance for issues concerning your housing, I’ve got a list of referrals. But then something catches me off guard. A client comes in for a routine appointment to check in with me and I notice he has purples bruises on his arms. Yes, he got the bruises a few days back. But he doesn’t want to discuss that, or the fact his arm is really hurting (which I can tell because occasionally he moans and grabs it). What he really wants to talk about is how the fan at his apartment makes noise and would I take a look at it? OK, we’ll address the fan, but first let’s get you some medical attention. The client didn’t want to go to the ER but was willing to let me make an appointment for him to see his doctor.

That's when the ability to think on your toes and ability to ‘fake it’ comes in handy. Not faking knowing something you don't, but faking confidence when you don't always have it. I didn't know what was wrong with my client but I recognized it needed attention. As a sidenote, I never knew my guilty pleasure of watching America’s Next Top Model would somehow relate to my case management job. More specifically, Tyra’s advice of “faking it” works in case management. For a person (for that matter it can be a client or a friend) who’s feeling anxiety or is upset it’s very reassuring to have someone working with them who’s able to say, “Let’s figure this out together” even if it’s a situation new to that case manager.

It's situations like those when I'm really not sure what to do I take a couple of moments to run over to another case manager and troubleshoot the situation with them. I'm extremely grateful to my coworkers for times like that.

Sunday, June 28, 2009

The Professional Who Works with You Has No Personal Life

I recently wrote a post pondering how clients feel maneuvering the social services (both non profit and governmental) system. The post seemed a bit naive as I thought a bit later about how when I need services like seeing my doctor I barely think about him having a personal life outside work. When I talk with him I’m focusing on my health and making sure I’m asking all the questions I want to ask as the hourglass quickly empties. Last week a coworker of mine said to me jokingly that our clients don’t even see us but see what they can get from us. A literal example of this was during Halloween when we were given the option of dressing up for work and only a handful of clients made a comment about how I dressed (a turtle). Although this may reflect the quality of my self-made costume… But some clients do see. There have been other times that clients were able to see through the calm demeanor I try to keep and read nervousness behind it, or anxiety for the client.

It’s still not a very natural dynamic, where only one person knows a good deal about the other person’s life. I do sometimes catch myself feeling bad that I’m expecting to know a lot about my client and yet the client knows very little about me. I also sometimes feel a bit hypercritical, like in situations when I strongly encourage a client to do something like throw away his stacks of old newspapers while for me it’s so hard to throw away old college papers and such (so I may not keep stacks but I keep too many). At least I know that my experience of giving helpful advice but not always using is not a problem exclusive to case managers.

Thursday, June 25, 2009

Odd/Uncomfortable Moments with Clients (2)

I look a bit younger than my 28 years and perhaps because of this clients have asked me on occasion how old I am. Better yet a couple have thrown me off by how casually they have brought it up. “My food stamps stopped and I don’t know why. So are you in your twenties or what?” Of course we can’t share personal information. I usually demure and say, “Old enough to do this job,” or “Let’s not talk about me, let’s talk about you.” A similarly uncomfortable question to hear is “Are you married?”

A middle aged client offered to take me out for coffee. When I told him case managers and clients need to keep a professional relationship he said, “That’s OK, we’ll sit in the back.”

Occasionally clients will ask me to use my computer which I suppose in itself isn’t the oddest request I’ve gotten. During one appointment, one client asked to use it and I told her this wasn’t possible. After 15 minutes she casually mentioned “Since I have pink eye I can’t—“ At this moment I mentally recorded each and every item she had touched up until that point and until the end of our appointment so I could disinfect them later.

A gentleman was meeting with me and told me that he believed his food was tampered with because he didn’t feel well. He then showed me a sample. Not of the food (but thankfully in a closed container).

One woman once left a message on my answering machine offering to sing at a meal at our soup kitchen. She offered to audition and sang an entire rendition of If I Had a Hammer. I'm fitting this snippet here though I thoroughly enjoyed it.

Also see my first post about this and my third post about this

Tuesday, June 23, 2009

Client’s Challenges of Managing Finances

Anthony is one client of mine who’s developmentally disabled and one of the challenging issues he deals with is budgeting. He receives a disability check and though he lives independently he relies on us heavily for support, including money management. It’s not exactly that I’m his payee because we don’t offer this service. The way it works is that after Anthony pays his bills I keep the rest of his money and he meets with me once a week to get a quarter of it in the hopes it would last him until the end of the month. From several years before I started working at the agency case managers have worked with Anthony in a similar way.

Anthony and I tried different systems and the weekly allowance method seemed to be more successful than the previous one. In the last system he’d get half his money upfront – around $175 – and then he’d contact me when he’d run out. What ended up happening is that he’d run out in the third week of the month and borrow money from other people and not always remember how much he borrowed. He would also spend at least $50 running up a tab at an overpriced grocery store.

Unfortunately, even though this system works better Anthony tends to come back an additional day a week, sometimes one or two days after getting his allowance and say he spent it all. With a bit of probing, I find out he spent a chunk of his weekly allowance (about $50) eating a meal out or getting candy from an expensive store.

After Anthony approached me a year ago and asked for help with his budgeting we’ve continuously talked about him ditching the expensive grocery store and walking an extra six blocks to the cheaper store. This month Anthony finally said he went to the cheaper store a couple of times, though he admitted he went to the other store too. It’s much more convenient to go to the closer store.

Today while meeting with me Anthony was ranting about not being able to hold on to his money and at some point he said “You don’t understand, I have no control over it (his money), once the money is out of my hands, there’s nothing I can do about it. Once they (candy man, restaurant, etc) have it I have no control over how they use it.”

Anthony seemed to insinuate through some odd logic that he doesn’t have control over his money by focusing not on his actions but on what other people do with his money once he spends it. I brought up the fact that an action needs to take place in between him having the money in his pocket and the money being at the salesperson’s hands and he smiled so I think he got that.

But something did click inside my head while he was talking about not having control over spending his money though he was referring to what other people do with it when they have his money. I looked at it from his eyes and I realized that he very likely has little control over it. He has become more independent in the last coupe of years I’ve worked with him, starting to pay his bills on his own (with his previous case manager she would take care of it for him completely) and following through with doctor appointments. But money management is something that will continue to challenge him because it’s that much harder for him to resist temptation of spending the money in his pocket. And the process of opportunity cost and thinking about "Is it worth to spend $40 here, but then all my money will be gone instead of spending it slower" is that much harder to. It feels good to have money and it feels good to spend it.

Sunday, June 21, 2009

Could You Spare Some Change?

Typically I don’t give money to people who ask me for change. I don't for a number of reasons, the main one being that I don’t know what the money will be used for [interestingly I’ve tried at times to give away untouched food and that’s a tougher sell]. I also tell myself that I can’t give change to everyone.* Around my agency I will usually be asked at least once a day for change. Sometimes I pass the same lady asking for change “to use the bus” twice in one day, on the way to work and back from work.

Two recent incidents brought two contrasting responses from me. A couple of weeks ago a friend and I were walking and an old lady stopped us and asked for 40 cents to buy her medicine. I used my usual line of not having change and continued walking, feeling guilty almost immediately for having said no. What if she was telling the truth? I reasoned with myself that if that was the case that someone else would surely give her forty cents. A few days later I saw a man, maybe in his late fifties, trying to use his transportation card to get on the train but it wouldn’t go through. After hesitating for a few seconds I used my card and let him get on. And then I thought – what was the difference in the two situations – why did I help one person and not the other?

I felt very sorry for the man who was blind in one eye and seemed to be mentally disabled. But I had also felt sorry for the old lady because of her age and because I perceive an elderly person to be more vulnerable than say, a middle aged person. But I hadn’t helped her, even though I had immediately felt guilty afterward. The fact I was helping a man get on a train seemed more tangible. If I was at the pharmacy and the lady would’ve held her prescription in one hand and stared helplessly at the pharmacist holding on to the bottle, I would’ve likely taken out 40 cents.

Interesting thing is that I’m much more giving when it comes to people who play an instrument, sing, etc. I feel like they’re doing something to earn their money and a part of me respects that a lot.

* Although it may be a crooked way to think that if I’m not helping everyone that it's somehow helping any one person.

Saturday, June 20, 2009

Another way to find out how a client is doing

I found out through an unlikely method where one of my clients is now. I had not heard from her in over a year. Initially she had heard about us from her landlord and came to my agency for a referral for dental services. She and I had only met a couple of times and she didn’t seem to want more intensive case management.

The other day I headed to the printer to grab a document and found a statement laying on the desk that indicated a client is now in prison. It was printed from a state database that’s open to the public. It gave a brief rundown of her personal info, photo, date of incarceration, sentence. She was in for possession of narcotics. I asked around and no one from staff had printed it out which was odd in itself.

Thursday, June 18, 2009

Reconnecting with an old client

I had a client come in today, a man I haven’t seen in over a year, and ask to see me. The client wanted to know if we had exercise classes. I said that we did, and my client told me he met with his doctor and was told he was in high risk to become diabetic. My client said that the doctor recommended he exercise and added he just returned from the library where he researched the disease.

I commended my client for taking the initiative of looking into it and offered to refer him to an onsite visiting physician we have who would be happy to give him more information. I also told him about the exercise programs we have. I was excited he was interested in the exercise classes.

I appreciate it when clients drop by or contact me after not hearing from them for a while. I don't expect clients I see only a handful of times to necessarily update me on how they're doing months afterwards but i like to hear from them. If I don’t, I hope they’re doing OK and if they’re not I hope they’re finding help wherever that may be. Usually I try to check in with clients if I haven’t heard from them in a couple of months (with more regular clients I’d check in sooner, maybe after a week) but sometimes clients move away, they don’t have a phone or they don’t respond to a letter I’ve sent them. I think sometimes about where they may be and how they’re doing. I’ve seen clients who saw a case manager at my agency as far as a decade ago. It’s weird to think that may happen again with someone else.

Wednesday, June 17, 2009

Avoiding burnout -- Distancing yourself from clients

To maintain some sanity for yourself as a case manager you need to keep your life separate from your clients. Have hobbies, hang out with friends, pick up running. Maybe not keep a journal about your work with them. Hmmm. Well, for me is therapy. My supervisor once told me that he feels bad that after a while of doing his job as case manager he got used to the pain. It’s a situation when you still empathize with the client but a part of you has grown numb to the pain – to the level that you are able to do your job and come back the next day. It’s part of the emotional distancing which slows down the burnout effect.

As case managers we constantly deal with peoples’ pain in form of illness, loss of family, abuse, poverty, loneliness. We’re not all therapists but we usually hear a good deal about people’s lives. I still hear stories that shock me. But experience has guided me to try and distract myself so it doesn’t take over my brain.

During my second month at my agency I scheduled an appointment with a client, one of the first I worked with, to apply together at the state office for food stamps. It was going to be the second time that I would be going with a client and advocate for him at this office (the time before another case manager had come along). I lost sleep thinking about it, specifically because I wanted something to go right for this man. He was in his 50s, and had had to quit his job a few weeks beforehand because he wasn’t physically able to do it anymore. Soon thereafter he was diagnosed with Multiple Sclerosis. He had only a distant cousin in the city for support. I was hoping that along with food stamps it would be possible for him to receive medical coverage too, based on the severity of his health condition. Unfortunately, he was only eligible for food stamps at the time we applied.

Some situations, like those you know the client doesn’t have a close support system apart from you, are harder to process. Then you realize you’re the person the client is looking to for support. It’s not easy to consistently be a rock for other people. I see people doing this for decades and I have the utmost respect.

Tuesday, June 16, 2009

Cable as Community

During my first year as a case manager I was a good deal more judgmental about the importance cable (and to a degree, cellphones) is to a good number of clients. When clients request financial assistance (i.e. with rent or utilities) we need to do a budget with them first. A few times clients would tell me that they spend almost $100 each month on cable or phone. Sometimes this would come to about 20% of their income. Towards the end of last year, when I knew our funds were low, I suggested to a client that in the worse case scenario, if we were unable to help, that one option he may consider may be not to have cable for a few months.

The client was a bit stupefied. “But I won’t be able to watch TV because I don’t have an antenna.”

Yes. I’m sure your cable will entertain you immensely once you no longer live in your apartment because you were unable to catch up on your rent.

Of course that was my uncensored thought. I’ve absorbed the case manager guide book – listen, ask the client what she wants to do, offer a suggestion, and go from there.

It took me a while to get over the fact that number of clients who pay a good deal more than half their income towards rent and barely make ends meet will still have cable. I finally learned to appreciate, though, that for a lot of low income folks cable is sometimes a sole source of entertainment, especially when going-out options are quite limited. It’s a way to treat yourself, to find comfort, to escape. But it’s still a bit tough for me to understand when people choose to continue and enjoy luxuries, such as cable, when they’re racking in debt, especially when their housing is at stake.

Monday, June 15, 2009

Some things that frustrate me about my job – Clients

Yes, I don’t mean this in the way that the job itself would be easier without them, but certain client related requests or occurrences, for sheer number of times they happen, bug me. Working this job has reinforced my respect for anyone who deals in costumer service, a field that tests your nerves and patience. And case management is a form of intensive costumer service. Overall I enjoy the work, but particular things bother me a lot…

1) Clients lying to me. Sure, sometimes you don’t know if people are lying or if their disability prevents them from understanding exactly what is going on so they don’t tell you the full story the first time around. It gets tough in certain situations though. For example, when I call management after a client comes in to ask for rental assistance, and while she tells me she’s only behind one month’s rent, it turns out that she hasn’t consistently paid rent since she had moved in 6 months before that.*

2) The Entitled Client who expects you to help them financially because that’s why you’re there. You’re the leprechaun holding selfishly to the overflowing pot of coins, so share the wealth, man. It’s not like it’s your money. Who are you, the case manager, to request to do a budget with this client? What a ridiculous idea.

3) A client starts telling me a story that goes something like this, “So after I came back from the doctor I went over to his apartment and talked to him and he told me that I needed to get some more money for it. So I told him that if she doesn’t help me there’s nothing I can do.”

This is more of a minor one but it happens again and again. Who’s he? Who’s she? I don’t know who you’re talking about if you don’t introduce the people in your story first!

A variant of this is when a resident who doesn’t have a phone number on record leaves a message without leaving a number and asks why no one will return his calls (once I had one resident leave me a number that was missing two digits).

* I get people lie, and I understand people are survivors and will do what they can to get the help they need, but it doesn't make my job easier or their request easier to process.

See also, what frustrates me about my job – Bureaucracy

Sunday, June 14, 2009

Seeking out New Clients

Marketing is not just for for-profits organizations. While businesses goal is to make money, non profits reach out to get money from various funders. Since our agency can't be measured in terms of financial gain, our funders measure my department's success in part by work we do with our clients (i.e. number of residents who remain housed) and number of clients we serve. Since our residents are under no obligation to meet with us this means a part of our job is outreach and seeking out clients. We have a few several hundred possible residents who are potential clients, not considering the turnover factor with tenants moving in and out so usually each month new tenants are moving in.

It’s odd to market yourself as a free service. “Get your case manager here!” Quite frankly, I’d want a case manager. I could use someone try to help me organize my life. Make sure I go to the doctor. In that sense I would be all over an opportunity to get a case manager.

A part of why we don't see more residents signing up for case management services may be an issue of pride. Not wanting to ask for help because they want to figure it out themselves. Also, if you (the client) have never heard of our organization how do you know it would help you? That’s why word of mouth helps and that’s one way we’ve gotten new clients – referrals from current ones.

What does boggle my mind is how residents who have lived for several years in the same neighborhood as my agency have no idea who we are. I once talked with security and mentioned this and said I don't understand how this happens, especially since we do a various programming on a fairly regular basis and have other departments that work with the community. “Easy,” the security guard said, “They’re asleep during the day,” and added that people wander in during the hours our soup kitchen is open because they see a lot of people come out of our building.

Fair to say that I’m sure a lot of people are doing just fine without us and sometimes I think about that, like what is our ceiling number of clients? It’s highly unlikely we’ll ever serve all the tenants in our buildings.

Saturday, June 13, 2009

The case of the lost check

“Miss Anatolia, you’ll never believe what happened,” Bill starts. “I got my disability check at the credit union yesterday, um, and I paid my cable bill there—“

He’s still talking but somehow I know where this is going.

“And then I went to the grocery store to get my food,”

Got your groceries. Very good. Then something happy happens?

“And I got home,”

Don’t say it, don’t say it.

“And I realized I didn’t have my wallet. I forgot it at the store.”


“Everything was in there, you know… The money order for the rent and the rest of my money.”

And naturally the request after that was will my agency help pay his rent, which at least is subsidized, but it’s still several hundreds of dollars. Here’s the thing, one, it’s hard to prove that you lost your money. Anyone can say they lost their money, or for that matter, that it had been stolen. A police report supports what the client says, certainly, but it’s not verifiable (unless it’s recorded in some way).

To be eligible for rental assistance a client needs to show proof how she got behind in rent. It’s easier to prove that you lost your job, that a disability check was cut for one month due to overpayment. Saying you lost your disability or pay check for that matter, means its tough grounds to ask for financial assistance. Along with proof of how you lost your money, you need to be able to show you can consistently pay for your rent and other needs.

Unfortunately we weren’t able to help in this situation, but my client was able to get help from another agency as a one time help. Sometimes it works out that easily.

Thursday, June 11, 2009

Turning the tables

Sometimes I wonder what it would be like for me to be a client. For the purposes of this this post I don't mean this in the sense of imagining very deeply what's it like to come from an abusive or difficult background -- that belongs in another post and thinking about all that pain can be overwhelming if you don't partially distance yourself from it.

I'm more specifically talking about a person asking for help and working his way through a social service agency. To walk through the door and ask for help. What does a potential client see when he comes in to our agency? What's he thinking about? You have people coming in with tangible requests. They have in mind the purpose of asking for rental assistance or asking to sign up to join our soup kitchen program. Straightforward request. But not everyone comes in with something tangible, some of them hear from a friend they should come to us. I think a lot about people who go through social services as part of their life, something they've done from a young age, maybe first through the public aid office, social security office, a type of bureaucracy that's part of their lives.

I even wonder sometimes if we could get mystery clients, on the play of mystery shoppers, people checking various soc service agencies for the quality of service.

I wonder what it feels like to navigate the system.

Wednesday, June 10, 2009

I hate waiting for the doctor

Of the things I hate doing, waiting for the doctor makes it in the top 10. And I'm not talking about a walk in, I'm talking I-made-an-appointment-but-still-need-to-wait waiting. I was waiting for two hours for the doctor with a client the other day. In the beginning the client was ranting off to me about an argument he’s had with his ex wife. After the first 30 minutes of talking, he calmed down a little, and both of us were left sitting there, without a book or an old Peoples magazine for comfort.

All the things I could’ve done during the remaining hour and half spent while/instead of sitting in the waiting room with my client waiting for the doctor to call for us:
… Taken a nap
… Encouraged the rest of the waiting room to join in in some group singing
… Taken 35 walks around the block or better, gone jogging, if that crazy thought ever possessed me
… Caught up on TV shows I didn’t get to see the previous two nights
… Picked up a new language

Notice how some fields it's OK to keep you waiting? Doctors have you wait, just so you go to another room, and then you wait for the nurse, and then she gets your vitals and walks off and then you wait some for the doctor to come in. Delivery people give you a slot, but at least you know in advance you'll be waiting. I just don't understand the need to make appointments if you wait for more than an hour!!! Maybe they should just give us an hour slot. You'll be seen between 3-4 PM. Somehow that would be better.

Why must so many doctors schedule 15 minute slots for their patients? I know there are a lot of sick people, but invariably they go over time and then they rush you like the building’s on fire.

Monday, June 8, 2009

The Beatles Taboo

I use some sites strictly to listen to music and usually can’t resist reading the comments that people add. Lately I’ve rediscovered the Beatles and listen to their songs every other day. Reading the comments I’ve noted a few things. One, that fan wars continue in regards to which Beatle is more talented and produced better work. I belong to the camp that viewed every Beatle as a necessary component that added to a product that was more than each of its parts’. I don’t argue any Beatle is more talented than the other. Second, repeatedly I see comments declaring the fact the Beatles “are the greatest band in the world always and forever," and more importantly lamenting that “No artists are like the Beatles today, there will never be a band as talented/inventive.” It's come to be a taboo to try and dethrone the Beatles from their royal status as the most innovative, groundbreaking band.

Back in the day I was completely obsessed with the Beatles and just drank Beatles all day. I started by getting my friends to sing the Yellow Submarine with me during recess in 6th grade, zealously focused on collecting their records, coveted their books that analyzed their songs and history, jotted down their name on one of my jeans, I was enamored. Now, at the age of 27 I’m looking at the band and I still enjoy their music immensely and have lately found them to be my default band to listen to.

But the more comments I read I realized that it couldn’t be it. The Beatles couldn’t be the best band for now and forever. We can’t just hang on to the past and believe no other band will be able to create something amazing like the Beatles did. They made many innovations and happened to make it very big. I do listen to artists today and I think a lot play safe, especially in mainstream. The unique, indie, or alternative artists don’t have the same outlet to be heard as easily as pop or rock. And American Idol well… They discover talent, but what about the talent of singing one’s own songs, writing one’s own songs.

Sometimes I find myself getting caught up in thinking about how it’s not possible to be original anymore when you write. At moments like that I try to remind myself that all stories are old stories (or formulas) rewoven and a new time frame, universe, adds a spin to it.. The Bible has some of the oldest tails, jealousy, love, hate, betrayal. If we stop to look at the Bible from only the perspective of stories, it can’t get more original than these tales. So Shakespeare didn’t write plays that left a mark on literature? Maybe another great band that will make it as big as the Beatles will take years to come. But we have to start thinking of it as when, not if. And keep experimenting.

Sunday, June 7, 2009

When One Client Became Homeless

I had been working with Louis for about a month when I got the call that he was leaving his apartment because the program covering his rent had ended. This wasn’t a complete surprise. In his late 40s, Louis had lived in the apartment for five months before seeking my agency. During the intake he told me he was concerned about losing his housing. His program state worker had visited him a few days earlier and told him he would need to move in a month’s time. Louis wanted help with finding housing as well as work. Since he wasn’t working I couldn’t refer him to a housing locator (because he had no steady income) but I did refer him to our job counseling center and offered to talk to his case worker on his behalf and find out what was going on. The last time Louis had worked was in the 90s and in a technical field that was no longer in use (something in printing), so I knew it would be difficult, but Louis seemed interested in working.

When I spoke with his program case worker, Stephan, I was told that he had in fact spoken with Louis several months ago and told him that the program would run out in a a few months time and that he would need to find a way to pay his rent. So I’m left to think was my client in self denial? Did he misunderstand? Could drugs play a role in his denial or lack of interest in finding work while the program was going on? Louis had told me he had been clean for 7 years but we do take our clients for their word until proven otherwise.

Bottom line the reasoning didn’t matter as much as the fact that deadline was fast approaching and no extension could be made because several people were waiting to take Louis’ apartment (as part of the program). It didn’t matter of course what I thought or what the misunderstanding was, what mattered is that Louis had a very limited time to find work or another place to live.

I found a transitional shelter for him but I was only able make him an appointment two days before he would lose his program, and the appointment was only an intake appointment to get on the waiting list to get into the shelter.

The day Louis lost his housing he gave me a call and I asked him if he would like me to walk over with him to a state department where they direct people with homelessness to a shelter for the night. Louis said sure. We met downstairs and he had a bag of his possessions, and we headed out.

I had went with him as for reassurance, since I knew he didn’t have family in the immediate area and to just have another person as support. I tried to make a bit of conversation on the way there but I was a bit at a loss for words. What kind of small talk to you make in a situation like that? As I was walking alongside him I was thinking – what does it feel like to be in a situation like this? Louis was quiet but seemed to handle the situation well, and it had seemed to me from the stories he had told me in previous meetings about his past that he had lived sporadically in various places and hadn’t enjoyed a lot of stability. Regardless walking into the unknown wasn’t easy. Since most of the people we work with in my department are tied in with housing I only have a small handful of homeless clients, on the rare occasion when it’s someone who had lost his housing, like Louis, who for various reasons lost his housing.

A few weeks after that I checked my messages and got one from Louis. He said he was he was staying at his brother’s apartment and that he’d call me later. He didn’t leave a phone number. The fact he had family he could rely on temporarily was great and not a lot of our clients have that. Also, unless our clients check in with us if they do lose their housing, if we don’t have a phone number for them we can’t follow up, and sometimes I do think about clients who’ve gone off the radar. Some randomly return, but some we’re left to wonder about.

Friday, June 5, 2009

Odd or Uncomfortable Moments with Clients and Staff

I keep some donated clothes in my office that clients are welcome to take. One  lady wanted to try on a sweater so she started taking off her jacket. Before I realized what’s going on, she’s standing in my office, only wearing a bra -- I was sure she had a shirt under her jacket, but alas, i was very mistaken. At that point I simply prayed that no male enter until she’s done.

I’ve had one client give me the website address to the first chapter of his book and asked me to consider to buy the entire publication, another try to sell me raffle tickets… Just like we can’t sell anything to clients, we can’t buy anything for them. Even if it’s for charity.

Having the helpful nurse at the health clinic that Joe and I go to explain three times, along with demonstrations (including squatting) how to give a stool sample as part of his physical. It took a lot for me not to laugh during her demonstration. She was so patient.

During the first year at my job I would often get calls from the receptionist along the lines of “There’s an old client of Berry’s here. Since you’re now taking his place, will you come and talk with him?” Berry was a senior case manager preceding me and I happened to sit in his office after he left. Because of this I somehow became the natural next case manager for many of his clients.

I’ve had one client call me to ask what my holiday plans were. When I told him I had plans with friens, he said that he had wanted to invite me to a site downtown to meet … his nephew.

Occasionally I go to appointments with clients. Last year, when I was still relatively new, I went with a client for the first time to the welfare office, and while the case worker is processing the case, she looks at me with a motherly smile and says, “You’re so nice! Are you in high school?”

Also see Odd or Uncomfortable Moments with Staff and Clients (2)

Thursday, June 4, 2009

Homelessness Prevention and Emergency Assistance

Homelessness prevention is my department’s main goal. Me, along with two other case managers, provide case management to six buildings in the city, amounting to around 1600 residents, and our goal is to keep these people housed. Originally the department was set up with the idea that case managers would mostly mediate between the residents and their landlords as well as help support residents (through emergency assistance) so they keep their housing.

I can attest for the last two years (that I've been at the agency) that we do some mediation between our residents and their landlords but I’ve needed to do that less recently. Other big forms of assistance are helping people catch up on rent if they’ve fallen behind due to a crisis situation, give food, and transportation (for specific appointments). All this falls under ‘emergency assistance.’

But really, day to day we find ourselves doing all kinds of tasks with clients that are not specifically emergency based, but support their wellbeing. That may include linking clients with physicians, addiction support groups, exercise classes, mediating between them and other family members, going to court with them, and so on.

Something else I like to do through my work is encourage resident empowerment. Early in my job I started working with a developmentally disabled client, Joe, who had a previous case manager who would do everything for him. Make his appointments for him with other providers, pay his bills, generally did a lot of handholding. Granted I still did and do a lot of that because of the level of Joe’s disability, but early on I would tell Joe that he’s capable of a lot more than he thinks. I understood that it could be an accomplishment for him to mail a letter on his own instead of having me send it, but I let him know as a way of encouragement that I respected his knowledge and experience. From my conversations with him and doing some of the regular tasks (especially the repetitive ones) I could tell he knew what he was doing because he would sometimes prompt me when I hesitated. People respond strongly to their environment, and I try to remember that when I interact with clients, although it definitely gets tough.

Wednesday, June 3, 2009

What frustrates me about my job – Bureaucracy of logging contacts

The fact that every single contact needs to be recorded. A contact may be an appointment, phone call or email to a client, or making a call on behalf of a client. If I call a client and she’s not there and I can’t leave a message, I still need to mark that as a contact. You also have to mark what purpose it was for too; budgeting/advocacy/referral/etc. The benefits? Very easy to track what we’ve done with a client. Drawbacks? You gotta set a few minutes aside after every contact to write it down. This is not easy if you get a few appointments right after the other, or you’re doing something and you get a call from downstairs that a client is upset and could you come and calm them down?

One problem that happens with that is when you play phone tag with a client, or when you make half a dozen calls on behalf of a client in one day. Usually in those situations I clump what happened in one or two notes because it's easier to read.

But we keep it because it’s a method to assess what we’re doing. How many contacts we have and what we’re doing. But it creates a situation where we spend a good amount of time logging what we’re doing, instead of… Doing our job. Some case managers write their contacts down in a notebook, which I admit I used to as well when I started the work. Then I got annoyed that I had to write the contact information twice, and by the time I had to put it on the computer I had 30 notes to write. I also like to be detailed, because “Case manager and client chatted,” which I have seen written by a case manager (and not just once) doesn’t quite cut it.

Monday, June 1, 2009

New Young Client

I have a new client, Janice*, who just turned 19 – the youngest client I’ve ever had. Honestly, her youth stood out to me because most of the people I work with are adults over 40. She moved to the city a little over a month ago. She’s not working but just started taking her GEDs. She doesn’t have kids or any contacts in the city. To get her lease signed she told management that she had a job. Through management she also learned about my agency and called us to find out about our services as well as resources to find work. We applied for Food Stamps together and I gave her information about pantries and women’s programs. We’re set to meet again to research job positions later on next week.

I have to hand it to people like that who just pick up their belongings and move across state to a new city. I don’t know if I would have it in me to do it. Granted a younger person doesn’t have commitments so in that way it’s easier, but when they don’t even have contacts in a new place they have to start from scratch. And I suppose finding out about our agency is one possible step on the way…

We do a new intake with each new client and sometimes you’ll finish a session and know as much about them as their family does. Sometimes it’s a struggle to get the basic facts – if they’re given at all (but those cases are very rare). Janice was in the middle of the scale. What drew her to the city was that she found it fascinating and she wanted to try life out in a new place. Maybe she’s hiding skeletons in the closet – even so, it may be that I’ll never know. The snag of not being a therapist.

* All names of course are fabricated.