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.

Sunday, September 6, 2009

Transferring a Client Out

I’m lucky I have the luxury to be able to transfer a client to another case manager. Sometimes clients are found ineligible for services upfront because we’re not able to offer services they need. Sometimes while they’re client due to inappropriate behavior (like aggressive behavior towards other clients or staff) they may no longer seek services. Other times a client’s mental health may become unstable to the point we can no longer help them (we don’t have suitable tools onsite, like no clinicians).

Other times something else may not work between a case manager and client. The right chemistry isn't there, a certain goal isn't being met but a case manager thinks a client would still benefit from services. This move is ideal in a lot of ways -- a client's still in the same agency but sees a new worker. Granted a transfer isn't something that can happen regularly but knowing that that option exists is reassuring. It’s sometimes the best course of action a case manager can take for himself as well as the client. I’ve transferred a client who flourished under her new case manager.

Until now I've transferred a few clients and last time it happened I was feeling quite anxious over it. Mostly thinking about the conversation that would take place with the client letting him know he would no longer be able to work with me. I had worked with Nick for around 8 months. He initially came to search for work and was referred to case management by his job counselor. It sounded like Nick had all but been estranged from his family for reasons he never quite completely explained. It sounded like his dad was a strong figure in his life at one point but that he had gotten in trouble when he was younger and didn’t graduate from high school. Interacting with Nick was tough – each time we spoke it felt like I had to establish rapport all over again. This was hard for me because I wasn’t used to doing that with other clients and because I didn’t make the switch that Nick worked differently. Although he would usually not be very talkative and challenged almost everything I said he kept coming back to my agency and our working relationship was quite intensive.

I tried to set goals with him and he would follow up on a few but then stop. I made a mistake as well by not being consistent with him since I wouldn't always make sure he'd follow through. Granted you can't force clients to follow through but I would sometimes cut him slack when I know I shouldn't have. I tried to give him constant positive reinforcement and encouraged him to think about responsibility and taking responsibility for his actions. Towards the last few weeks I would look at our upcoming appointment on the schedule and just feel bad, like I was already expecting the mental battle we'd go through when I’d see him.

It didn't happen quickly but eventually I realized that it was an unproductive and to a degree an unhealthy working relationship. We weren't working towards any goals. We'd start bickering because I let Nick press my buttons. And then Nick told me, though he didn't spell it out, that he had developed feelings for me and I knew that that was it.

It wasn’t a difficult decision to come to in the sense that clearly Nick and I shouldn’t continue to work together. But a part of me couldn’t help that I failed him as a case manager. I learned how I needed to work more effectively in the future I learned it through making a mistake with him. Maybe these are remains of this faulty idea I had of being some sort of savior for another person, which I know is not my role. But I felt it more on the human level. I wanted to help him, but I wasn’t able to.

The good news was that it was possible to keep him in the program and that if Nick agreed to it, he would be transferred to another case manager who was willing to take him. The one thing I was thinking about was how Nick was going to take the news. I had my supervisor sit in on the conversation with he and I because while I wanted to be the person who told Nick he would be transferred to a new case manager I wanted support with me. On the advice of a coworker I never used the word “decision,” in a sentence like “A decision was made that.” I talked about a move, a change, something that would work for Nick. When Nick understood what I was talking about he made a motion to walk out, pushing his chair back, but not actually getting up. He didn’t say much for the first 5 minutes, but then he started nodding and responding. I still felt some hostility from him but in end it went really well. Indeed I had overthought the conversation too much in terms of him taking the news badly. My supervisor introduced Nick to his new case manager. A few days later security approached me and let me know that Nick tried to push his boundaries with his new case manager in the front lobby but was put in his place* and that he was treating security with more respect. Power of social psychology is fascinating.

* 5/28/2011 Rereading this I don't like my usage of "was put in his place." More appropriate to state that the case manager addressed this immediately whereas I didn't necessarily do this consistently.

Saturday, September 5, 2009

Cool Experiences and Feats – Clients

What started as a prospective root canal turned out to be a recommendation that a client get all his teeth removed because they weren't in a reparable condition. As a result he went through the procedure to remove all his lower teeth and 6 of his upper teeth. All these teeth were broken and needed to be removed for him to be fitted with dentures. The entire process took 4 months but he completed it and received his dentures. [Now if only he would wear them]

A client of mine mentioned casually attending a Beatles concert. When I asked him how it was, he said he couldn’t hear the band and was so far away they seemed tiny onstage, but that it was “history”. Another client boasts she’s been at 100 live concerts (she keeps a written list of them), including Pink Floyd, Bruce Springsteen, and the Grateful Dead.

A client who suffers from a developmental disability and schizophrenia recently completed his first year in community college where he’s working on completing his GED. After working last winter as a greeter at Walmart he’s partnering with my agency to find part time work.

Cynthia's efforts to clean up her apartment and throw away much of her belongings before moving to a new apartment.

Thursday, September 3, 2009

More than One Way to Help

I was pretty excited about starting to work with Ann on a specific goal and then she missed her appointment today. I was a bit disappointed. I've been working with Ann for a little more than a year now. She lives with her boyfriend and a 5 years old daughter. The boyfriend has a mom who's chronically ill so though he lives with Ann he occasionally visits with his mom for a week here and there to help her out. Ann also has a friend's daughter, a teen, who stays with her on occasion (in the last 6 months at least a few days a week) and Ann tries to do what she can to help her with food, clothing, and the like. She has told me that at times she will eat little so that the rest of her family can eat.

My agency has helped out the family financially in several ways over the years (from clothing to rental assistance) since Ann had a couple of case managers before my time. While I know her requests have come from a place of need and I know she has a lot of expenses and generally a lot on her plate as an outsider looking in I see where she lacks some life skills. She has said to me on several occasions that she struggles with managing her money. She's in her mid 20s and has told me that she never learned how to deal with things like paying overdue bills and said she feels she doesn't have life skills to deal with a lot of things life throws at her. And I admire the efforts she has continued to put to provide for her family and the sacrifices she made for them. But it's still hard for me to see her make mistakes that are avoidable. For example, she once came to my office and said she owed a good deal of money to a certain provider. I offered to call the provider to work out a payment plan and Ann said OK. I made the call, a plan was made that Ann said she could follow, but then the following month she still went ahead and paid the entire amount. Since that money was used for the bill, she didn't have enough money for public transportation for herself for half the month. Perhaps she paid the entire amount because she panicked. Maybe she did it because she didn't take the lead with the call and she didn't feel like she owned the resolution of her problem.

It seemed Ann continued to have financial issues because she would occasionally contact my agency for help. She was always grateful and it seemed hard for her to ask for help but because of our own limited resources we weren't always able to help her. At times we weren't able to help I would give her alternative resources but she wouldn't always follow up with them.

While Ann has relied on me for emotional support over the time we've known each other I hoped she would be interested in working with me, anyone, on developing some of these skills that none of us our born with. Certainly not me. I couldn't force her but I encouraged her to work with me on some of the issues she told me she struggled with -- budgeting, making long term goals, developing her independence.

Finally last week it sounded like we were on the same page and Ann said she'd bring bills to our next appointment so we could start sorting them out. That is one area that sounded like it was particularly overwhelming. Then today she didn't show up and when I tried to call the line sounded like it was disconnected. Ann eventually caught up with me and said that she had overslept that morning. We rescheduled the appointment for next week. I hope that this will be a process of us working together on these goals. These are the types of services we offer that I'm especially excited about because it feels like they would make a greater difference in the long run.