Friday, July 31, 2009

Journal Labels for All

I’ve noticed I often use labels (similar to what I have on the right side of this journal) to navigate through other peoples’ journals, especially when they’ve written for years and don’t publish the titles of their individual posts.

When it comes to social work journals, I typically look for what most closely resembles the type of work I do / situations I find myself in. ‘Rants’ will get picked (though these would be picked in virtually any journal I’d be reading), ‘attitudes’, as will ‘homelessness’, ‘crisis’, and ‘bureaucracy’. I’ve found some interesting books through reading other peoples’ book reviews so I’ll always be intrigued by this option. The words I’m least likely to pick would be topics related to the weather, animals, or names of people I don’t know.

I also realized that without censoring myself I would quickly end up with hundreds of labels. Then I end up with random labels like Susan Boyle, who I will only probably have one post about but I needed to label that post with something. Do you use labels when you’re reading other peoples’ journals? What do you typically choose?

Tuesday, July 28, 2009

What do Four Dollars Mean to You?

I was sitting behind two women on a bus and overheard a brief exchange. One shared an experience she had on the bus the day before. She said that a “homeless person” got on and held out a number of coins in her hand. She told the driver she was homeless and that she only had part of the bus fee. The driver waved her off without her paying. Once she sat down she took out four dollar bills and counted them out. “It’s not right,” the woman told her friend. “The bus ticket was less than $2. She should’ve at least paid something. It's one thing for homeless people to use the train for free, but I don't even think she was homeless.”

Sure, on a purely theoretical level I understood this. The concept of paying for services because that’s what the collective everybody does. But saying that statement out loud, “counted out four dollar bills” and not catching yourself and thinking, wait, is that right?

She counted out four dollars. Four dollars! I’m sure she didn’t wait to put that aside for her mortgage payment or her second installment on a new plasma TV. It also seemed like these $4 made the difference for the passenger being viewed as a person not experiencing homelessness.

The point of me sharing this is not to knock this woman down. In fact, this is an encouragement for us to talk our thoughts out loud. I’m the first to admit I’ve had thoughts that only once I shared them I realized they made much less sense than they did in my self serving brain. Though who knows, maybe this woman was a person who follows the rules absolutely and with no exception and just couldn’t see the perspective of what $4 may mean for someone else.

Monday, July 27, 2009

Empowerment and Snails

When I was about ten my dad had a brief stint with snail farming in our back yard. I came home one day and found a snail making a courageous escape and sneaking away. I later commented about it to my dad. “I’m letting it go,” he said. “If it was able to figure out a way to escape, I’m rewarding it.”

This way of thinking has stuck with me. This anecdote doesn’t translate as smoothly to the framework of my agency except that I translate it to clients being encouraged to feel empowered and take initiative. It’s true there’s no doubt our clients are survivors and take action to help themselves. If not through a network of friends or acquaintances it may very well be through our agency. But because we have limited resources it’s tough for us to become someone’s sole resource of support, especially when it comes to being relied on exclusively for needs like food or transportation. So in this sense initiative may be as simple as a client going out of his way to find help from other resources. Last week a client showed me a map he got from another case manager with a location circled on it for a food pantry. He told me he was going there that day to get a food bag. Now the question is, would I be inclined to want to help him more should he come to our agency and ask for a food bag in the future based on me knowing he took these extra steps? It's hard at times to be objective. There are a lot of variables.

Tuesday, July 21, 2009

Client Validation

I had the opportunity to sit in on a presentation by a director of nursing home. The nursing home houses both elderly folks and people experiencing mental illness. During one section the director discussed orienting new workers and interacting with the mentally ill residents. Her discussion of validation made me think a lot about one specific client of mine. She gave the example of a worker being approached by an upset resident. If the resident starts engaging the worker in conversation but the worker isn’t able to converse at that moment, the worker needs to validate the resident. Makes a lot of sense. Validation shows the resident that the worker is listening to what he’s feeling, that what he’s feeling is important and that the matter will be addressed later.

I agreed with this. At the same time I also thought, what happens when that validation needs to take place constantly?

During the discussion that followed the presentation I brought up my question concerning my client, Dina. Dina catches me 2-3 times a week in the lobby and with as little as a “hello” will launch into a tirade about a particular difficulty she’s facing. These topics are usually repetitive and ones we’ve discussed many times over the past year, mainly concerning relationship problems she’s having with her friends, boyfriend, and family. For a couple of reasons I prefer not to have these talks in the lobby. Confidentiality being one reason. Also, I don’t always have 10-15 minutes each of those mornings – and even this amount of time won’t be enough.

So I asked for advice as to the best way to deal with a situation like that. The advice I got was to validate the client and keep it brief. Say that I understand client wants to discuss something that’s bothering her, that I think it’s important to discuss, and set up an appointment to follow up. In the past I did try to explain to Dina that I’m not able to discuss her personal concerns in the lobby and she seems to understand me, but while she’s in the middle of a rant it’s very difficult to stop the flow of her words. And worse, sometimes when I try to say something she responds that I don’t care about what she thinks, even though later on she says that she didn’t mean it. Which I understand because I can see that when she’s ranting to me that she’s in a different state of mind.

To make matters a bit more difficult my client is developmentally disabled and even though we’ve talked about her concerns and ways of addressing them it’s very hard for her to change the way she responds to conflict. I feel my limit at these times. I know I’m not a clinician and I know that my agency can’t be this person’s sole support. I see where her anger is coming from – isolation and feeling like she doesn’t have a real source of support. I also see how she’s so focused on her feelings of loneliness that it’s nearly impossible for her to step out of them, and I appreciate just how difficult this is for anyone. Recently, after months of discussion, my client and I came to a decision that it would be helpful for her to meet with a psychologist. It’s hard to see her in such pain and I hope that it’ll be a valuable resource for her.

Saturday, July 18, 2009

Case Management Humor

Due to budget cuts and low cost mental health clinics shutting down, clients experiencing mental illness will now be providing therapy to one another.

(Discussing a client who’s notoriously late or misses his appointments)
Coworker: He had one appointment earlier today with me. He was probably too exhausted to make the other one.

Coworker: How are you doing?
Coworker: Ask me tomorrow.

Client calls out to me in the lobby: I’ve been kicked out of St. Nick’s soup program! (holds two thumbs up with an exaggerated smile)

Also see Case Management Humor (2)
And Odd or Uncomfortable Moments with Clients and Staff

Wednesday, July 15, 2009

The First Moment I Thought “What am I Doing Here?”

I suspect many case managers ask themselves this question at some point, especially in the beginning of their career. This is a variation of “What have I gotten myself into?” Today I met with Cynthia, the first client with whom I had experienced this question over a year and a half ago.

I was still pretty new to the case management job at that point, it was around my second month, and I had left my agency to go on my second home visit. I was going to meet Cynthia at her apartment after meeting with her a few times at my office. She had invited me to see her apartment after she shared with me that she had a few concerns about it, specifically the order in her home, as she called it. “I don’t want to lose my housing,” She had told me and said she was in a state program that covered her rent and that she was told by her case worker there that she wasn’t meeting the requirements for “organization in my apartment.”

As I reached Cynthia’s apartment I noticed a syringe lying on the carpet. I knocked on the door and Cynthia answered with a smile. We exchanged hello’s and I looked down to point out the syringe when I noticed a second syringe in Cynthia’s apartment. When I asked her about it, she said she was diabetic and kicked the second syringe inside the apartment before picking it up and throwing it away. Though it turned out she was telling the truth (and she didn’t seem under the influence of anything when I visited her), watching her carelessly deal with these used syringes unsettled me.

So as I entered her apartment I already thought, I’m over my head… Outside the comfort of my office, in another person’s home, the second home visit I had ever done. Seeing these syringes. And when Cynthia opened the door wider I saw heaps of newspapers, bags, and other household items lying on top of one another with a small empty space in the middle of the studio apartment. Yes, a studio. A friend of Cynthia's was sitting on the floor, leaning against newspapers, smiling at me.

Cynthia was indeed in danger of losing her housing for not complying with her program’s rules, specifically concerning the condition of her apartment. Because she had no income and was applying for disability losing the apartment meant she would become homeless. Odd thing was her belongings looked like they had been building up for years – I saw newspapers dating from 2 previous years. I don’t know how she had managed to get away with the state of her apartment looking the way it did.

Clearly what needed to be done was get rid of a majority of her dirty, broken, or unusable items, but of course this was extremely painful for her to do since she was attached to her belongings. At the end of the process, Cynthia needed to transfer to a different apartment and another case manager and myself spent a good part of a day working with her to go through her belongings and try to only take clothes, usable household items.

Just to add: In this context the question “What am I doing here?” doesn’t refer to burnout, but to feeling overwhelmed.

Monday, July 13, 2009

Movie Scenes I’d Like to See Visited in Real Life

A few years back I would get a kick from watching scenes where a tumbleweed rumbled by. For some reason that imagery struck me as incredibly entertaining. Life was simple back then. When I think about it now I’m not sure why I found that scene so funny. Not only that but actually seeing a tumbleweed in real life made me laugh too (this happened a bit less often). Here are a few current scenes I’d like to see replicate themselves in real life.

People spit their drink upon hearing something dramatic.
Called the spit take, a character spits out her beverage after hearing something shocking. Like that what they’re drinking isn’t beer, though usually it’s because something surprising has happened. My goal is to make someone laugh and do this. Granted I don’t think I want to be washed with my friend’s drink so I suppose some strategizing would be needed – maybe walk them outside so no one would have to clean anything up while they’re still holding their drink. Something smooth like that. The closest reaction to this that I’ve ever gotten is laughter followed by my friend putting his head down quickly and grabbing a napkin.

A little bit of synchronized dancing and singing.
I admit I enjoy the occasional musical and that the idea of going through a day with an occasional song and dance amuses me greatly. That’s just what I need during a day at the office or as I’m doing routine tasks like waiting in line.

Be able to walk through a mirror
That scene in Disney where Mickey Mouse goes through the mirror and weird things happen, like his coat hanger starts moving. A similar development takes place in Alice in Wonderland (TV movie). It’s not that furniture coming to life excites me but I always thought the concept of an alternate reality through this device (mirror) was cool.

Saturday, July 11, 2009

Book Review: Self-Made Man

Journalist Norah Vincent shares her experiences posing as a man for a year and a half. As “Ned,” Vincent tries to hit on women, find applies for work, goes to strip bars, and joins all male groups like bowling and an all-male monastery-like setting as she tries to understand what it’s like to be a man in a “man’s world”. She seems to be incredibly successful in her costume as well as her persona and seems to pass as a guy in virtually all these settings.

The concept of this book caught my interest. I’m fascinated by these journeys people take when they infiltrate a different aspect of society in camouflage as it were, like in “Black Like Me.” It’s interesting to also learn how their perceptions color their experiences.

After completing the book I realized something about it didn’t quite work for me and initially I wasn’t sure why this was. I considered that maybe it was partially because Vincent didn’t reveal men to be a People of a Different Species that Dr. John Gray (just to pick on one) would want me to think.?

The truth is also that the first chapter didn’t capture me. This is where Ned joins a men’s bowling group. I guess this relates back to what I wrote previously. The guys’ conversation was pretty mundane. I was also less interested in the all male group chapters because what interested me more was to Vincent’s experiences hitting on women and getting a job.

Vincent’s insights as to how men treat one another compared to how women treat one another was intriguing. Based on her experience as Ned, men weren’t as willing (compared to her experiences with women) to share their feelings but despite this, according to Vincent, they shared a strong bond. Vincent made a point that she felt this bond to be stronger than what she felt with other women. So does this mean you don’t have to share feelings with one another to still feel close?

Throughout it the 18 months as Ned, Vincent found it she had to be on constant watch of how she behaves and found it hard to express herself as easily as she would if she was a woman for fear she would be exposed as a woman or seen as feminine. Incidentally she also wrote that what made her masculine as a woman was no longer masculine when she was a man. I wondered if she would’ve expressed herself more naturally if then her experience would’ve been different.

I recommend this book for entertainment and because it’ll fairly certain it’ll likely make you think.

Thursday, July 9, 2009

Tempting Sight Down the Street

There’s this gorgeous park not too far from my agency but most of my clients (the same who live in buildings in neighborhoods nearby) don’t go there. Some because they’re not mobile, others because it’s not on their radar. A couple of my clients will go downtown on occasion to get away from the neighborhood but not necessarily walk a few blocks to the park.

It’s the perfect weather to be out there now. And I can look at myself to understand that it's hard to appreciate what's right down the street, since I just recently discovered the beauty of a park near my building. Is it a slightly acceptable excuse that I haven't frequented it because it's about 6 blocks away? Maybe not. But though it's a good walk away it’s so relaxing. I watch the trees and lie on the grass and see other people run by. And feel even more relaxed that I'm not the one running, just watching.

A few months back I toyed with the idea of suggesting to my supervisor that we organize a grill/picnic event for our clients. I figured the park near my agency would be the perfect locale particularly because it would be so easy to bring them there. However, the idea that we may be visited by 600 additional guests at our party worried me and my supervisor (many people who're experiencing homelessness stay at the park during the summer) – mostly in the sense that we’d run out of food. In the end we had a lot of events going on and the truth is I was a bit frustrated that my department wasn’t very enthused with the picnic idea, so it was dropped.

We are having our annual agency-wide party for our clients soon though, which is a pretty large and fun event because we get to interact with clients in a social atmosphere and they get to meet one another. We even entertain the clients’ kids which I’m sure is exciting for the parents. I’m looking forward to this.

Monday, July 6, 2009

Empowerment to the People

This past weekend I thought a few times about one of my clients who was facing a serious challenge yesterday. Anthony, a client I work close with has a developmental disability. He also has a nephew, Jim, who he’s very close to. Jim suffers from a severe genetic disease and stays in supportive living in a different town. From what Anthony has shared with me he and Jim’s brother are the two most present adults in Jim’s life and Anthony calls Jim regularly. Maybe it’s because Anthony didn’t have a child of his own that he feels fatherly towards Jim. About four years ago Jim moved away to a different town and since then Anthony has seen him sporadically. Since he can’t drive he relied on friends to take him to visit Jim. The infrequency of his visits was a constant source of pain for Anthony. He shared with me that Jim didn’t have a lot of support outside of him and Jim’s brother and that he missed him a lot since he moved away.

One of Anthony and my goals was to empower Anthony to be able to make the trip to see Jim independently. Anthony’s friends drove him to see his nephew so the only time he took public transportation was with another case manager went with him about a year back. Since no direct route existed the trip included changing three buses, hopping on a train, then getting a taxi. Not to mention keeping an eye on the clock to know when to leave.

Last Wednesday Anthony told me he wanted to see Jim on his own. I asked him if he was sure he was ready to do it and Anthony said that he needed to and essentially said it was time. So we went over the directions and he kept copies of the train schedules, map, and directions. We went over the cost of the trip and Anthony said he’ll take extra money with him. I encouraged him to ask for directions or help if he got lost and he wrote down a relative’s number just in case.

Then of course over the weekend I thought about him. I knew money-wise he’d be OK if he’d be able to hold on to his money. The trip would be something he had never done before on his own and I was mostly nervous he’d get lost, be too shy to ask for directions, and get frustrated.

Just as I got off the bus to work I saw him walking towards my direction on the street. He nodded at me and his posture seemed relaxed. I asked him how the trip went and he shrugged his shoulders. “You won’t believe what happened,” Anthony said to me in an inscrutable tone. “I took the first bus and then I got lost! So I asked someone how to get to the train station and he showed me.” I quickly understood that Anthony walked from the bus station to the train station instead of taking one of the four buses that were nearby. This was quite far – more than two miles. Unfortunately he missed the first train so he had to wait 2 hours for the next one. “I didn’t know if I wanted to stay and wait,” Anthony said and added the rush of the “mobs of people” at the station when the later train came upset him. But he got on the train. He quickly realized it was going in the wrong direction and asked for help and got on the right train. At the train stop at the second town the security guard let him use his cellphone to call a taxi. So in the end he made it four hours after the time he had planned to make it, but he did, and I couldn’t congratulate him enough. I was so excited for him and very proud. It knew it meant a lot for him to have done that on his own and it was great to see him at ease having seen his nephew. I was so happy I practically skipped my way to work. And I’m no skipper.

Sunday, July 5, 2009

I Didn’t Have to Know

I started making a list of things I wish I would’ve known before becoming a case manager but I quickly stopped. I realized the list wouldn’t have meant much at that point. It’s not that I walked blindly into my job. I knew I’d be working with low income people in a poorer neighborhood in the city. I recognized that as a person who had grown up in a sheltered environment that most of the situations I’d be dealing with would be new and unfamiliar. But now looking back I also see that advice that supposedly would’ve been made it an easier transition for me wouldn’t have worked.

A couple of weeks before my first day at my agency an older man at a mutual friends’ party told me that my job would be difficult because I’d be telling other people, often seasoned professionals, what to do when advocating for my client. Hearing that caused a bit of anxiety for me, but more than anything it was because I knew I hadn’t taken that role before. Most of what I was going on in terms of work expectations came from its job description.

In the back of my mind I had thought that after graduating from college I’d do something with writing since that remained one constant passion for me. A pretty common passion too if to go by splurge of online journals alone. It really is unfortunate I didn’t love doing something else as a child, like engineering or nursing. The ease of finding work then! It may have also been harder to qualify for writing positions because I didn’t have a degree in English or Creative Writing. I had graduated with a BA in Psychology. I had majored in Psychology because I liked the field but I wasn’t sure how it would translate into a job. Psych undergrads have fewer options for one thing. While I had worked with juvenile kids for a year at college I didn’t necessarily want to continue working with kids and I lacked experience working with adults. So as I scanned through online ads I ignored most case management positions because I didn’t think I had enough experience. Also, quite frankly, they looked intimidating, and not just the inpatient positions. I would be clearly outside my comfort zone which consisted of myself, my computer, and one other person at a time. A couple of months into the thrilling life of fruitless job search a professor emailed me a position he had heard about from another professor and I read it and thought, worth a shot.

I took a close look at the job description. Emergency assistance to six buildings, OK. Breakdown of duties: Going to appointments with clients, OK. Doing intake, not sure what that would entail, but I’m sure they have forms and it involves asking questions, I know who to do that. Keeping statistics, I have some memory of SPSS if that’s what they mean. The tasks themselves didn’t seem like something I couldn’t do.

I didn’t know how those duties would translate to day to day work. So if someone would’ve told me what to look out for or given me advice I wouldn’t have been able to do much with the information. And a lot of it I wouldn’t have wanted to know. Burnout would’ve meant very little with me being all bright eyed and excited to do some hands on work. If someone would’ve told me that I may lose clients to illness or addiction, would I want to think about that? Would it have meant something to me not having had that kind of professional relationship with someone?

It worked out OK not knowing.

Saturday, July 4, 2009

Developing a Sense of Community among Clients

Social capital supports people immensely. Social capital in the form of having relationships with families, friends, support through a faith based group or club affiliation. Some coworkers hopefully. Maybe a friendly baker.

My clients’ lives are that much more difficult because they lack social capital. The department I work for provides case management to 6 buildings whose mostly consist of tenants living alone. Those without kids have families spread out throughout the state or beyond and this is even truer of our elderly clients. The majority of our residents are recognized as disabled by the state for mental or physical illnesses. For many their medical conditions or addictions prevent them from developing sustained friendships with others. Not to say everyone lives in a bubble on his own, but if people have friends these tend to be pockets of friendships. Maybe the lack of having a strong social network is more typical of a city but it’s unsurprisingly a real hindrance in some ways. Sometimes people don’t know or trust their neighbors to the degree that they don’t want to gather with their neighbors to speak up collectively if there’s something wrong with their building. Like in the cases it’s infested with mice or roaches. We do individually advocate to landlords on behalf of people, but we don’t take part in mobilizing the clients to take group action. We encourage clients to reach out to the other tenants in their buildings but often we hear the response that they don’t know the people in the complex or don’t feel comfortable in approaching them. Combine that with fear of retaliation from management and it slows down clients banding together to take action.

So the supportive network these people lack my agency tries to fill in – through the program I work for and others that cover a larger part of the city. Some clients thrive on the programming we do, and are either well established with one case manager or are tied in with our onsite physician, soup kitchen or exercises programs.

Next month a case manager in another department is going to take a group of her clients to a fair and suggested that we advertise it to clients in my department because it’s in the neighborhood (where the six buildings that fall under my program are located). I thought it was a great idea and told her I’d help spread the word. Getting residents to go to an event like that together may help sew seeds that could lead to friendships. Let’s start with that.

Wednesday, July 1, 2009

Self Disclosure to Clients

I had a brief back and forth discussion with AntiSWer about social workers disclosing their age and marital status to their clients. I don’t think it’s wrong to do this, but for some reason I thought that it was common policy that social workers/case managers not reveal this. Which I base on my one current job as a case manager. I'm curious as to how other social workers deal with this. For me it’s also partially a gender thing. Meaning I would feel more comfortable talking about my marital status/age with a female client. Sharing personal information about whether I’m married or not with a male client may develop into a discussion so I'd rather cut the possibility off at the start. But though I don’t share those details I do talk about where I’m from, where I grew up, my family, etc.

On the same topic of disclosure, over the past couple of days I was going through a rough time (non work related reasons) but I decided to go to work because I couldn’t stay at home with my thoughts. I met with one of my clients and I suppose I was a bit scattered because she said to me "What's wrong with you?" Evidently my attempts at pulling a calm demeanor weren't successful. Though on the other hand, she’s usually direct and brass with staff and likes to constantly test her boundaries and my patience. While we were at my office and she asked me again that it looked like something was on my mind and for an instant a part of me wanted to tell her what was going on. Not to make her feel bad that she was giving me a hard time, but to make a connection. Like see, I'm human, things happen to me too, I'm not just a blank page. But of course I held back. Oh the censorship that goes on so we keep it a professional relationship. Anyway, the sharing of woes is for family, friends and a few coworkers, not clients. Another client was telling me the other day that she stopped seeing her therapist because she started to talk with her about her marital problems. That's why therapists need to see other therapists! Constantly keeping that facade regardless of how you're feeling though, that's tough. Especially because we invite our clients to share how they're feeling with us all the time.