Monday, May 31, 2010

Client Stepped Outside His Comfort Zone

Louis, a client of mine inspired me last week. Louis is middle aged and is extremely focused on the death of his late wife. Still devoted, he talks about her constantly. She passed away two years ago and since then Louis keeps to himself, leaving his apartment strictly for errands or to see me or his doctor.

A coworker stopped by my office and told me he saw Louis speak in front of a large audience at a rally relating to a city ordinance concerning health care (Must. Remain. Vague). My eyelids flew open when I heard this. This is a man who had almost shut himself out from the world. The fact that he was moved to be involved and talk in front of a large audience amazed me. I'm not sure whether he had any fear of public speaking fear fear (this may be just may projecting my anxiety unto him) but the act itself, which often causes anxiety in people, impressed me.

He inspired me. It made me want to push myself as well. I sing and dance (granted maybe not here so much) about how much I get outside my comfort zone but to what extent do I do that? What can I do to push myself? Hmm.

Sunday, May 30, 2010

Clients Appearing in Twilight Times

Signs to me that I need to do more to separate myself from work:
Heard a client in my head -- I don't know if I'm unique in experiencing this -- but as you get to know someone you become familiar with her phrases or repeated statements she makes. In the last two weeks a couple of nights as I was falling asleep I could hear a couple of my my clients' phrases as I was falling asleep the other day. Not full fledged sounds, but echo of their phrases.

And yes, it happened: A client appeared in my dreams. Ah! We didn't interact and it wasn't a scene where I'm talking to someone and my client's standing in the background sipping coffee (like a variation of Where's Waldo?). He was one of the silent participants wandering around. While we have no power over our dreams it made me realize that if a client is venturing into a dream -- perhaps it is time for a short break from work. Like to another city perhaps.

Friday, May 28, 2010

With Some Form of External Support, This Will Get Done

[For the sake of this journal and the following story, from this point onwards I'm calling my agency Empoder -- short for empoderamiento = empowerment in Spanish]

George, a client who has several mental health conditions that impair his ability to perform daily living skills on his own without some support (i.e. budgeting, advocating for himself). He and I worked closely in the last two years on issues relating to mental and physical health as well as budgeting and I've seen him becoming independent in some aspects while being aware of his limitations. For example, George knew about his move in date to a new apartment for some time, but was having -- understandably -- a very difficult time getting prepared for it. Another agency was helping him but it looked like they weren't reliably involved in the process.

As weeks went by and we better understood how much prep work needed to still be done and the scope of what needed to be done in addition to packing (that the other agency wasn't doing) we started becoming a lot more involved in the process.

Each time I met with George the past month -- which was typically around 2-3 times a week, he would often say, "With God's grace I'll get through this. He's there when no one else is," and go home and not be able to get much done because of his own barriers.

A coworker of mine met with George last week and he was in a particularly talkative mood, talking about his love and trust in God. "God is going to help me move to my new apartment," he said, "God is going to see me through this." My coworker later confessed to me that her instinctive response to this: "Yes, with the help of God -- [emphatically] and/ Empoder!"

Tuesday, May 25, 2010

She Found Meaning in Randomness

Harriet has worked with me for the past year and a half. She first sought case management services because she needed rental assistance. We were able to help her and since then mostly we've worked on finding her elderly mom supportive services.

Harriet and I had a long conversation today. She told me 5 of the tenants in her building (2 on her floor) died in less than a year. Harriet doesn't live in a nursing home -- most folks are in their 40s and 50s. Harriet is in her mid thirties. As she talked about her life now I listened to how these deaths changed her views of God, of having kids, of her relationship with her friends and family. It made me think about how our environment affects us and the influence death has over us too when it's close. Harriet talked about a growing divide she felt from God and the randomness in which things happened to her neighbors.

People have a strong need to find meaning or reason behind what takes place and I thought it interesting that Harriet was finding meaning in randomness. Yet Though she wasn't finding meaning behind why it was these deaths were happening she was reconsidering what was important to her.

Tuesday, May 18, 2010

Caught Myself Getting in an Argument with a Client

Case management is all about a dance -- though I suppose it's possible to extend this to most interactions. In case management it's a dance involving knowing when to push. When to explain yourself. When and how to listen. When to take a step back.

I caught myself starting to argue with a client today. Not an angry exchange of words or anything like that. My client was asking me why we were going to do something we had previously talked about and was nitpicking at my answers. As I started to argue back I realized he was only giving me a hard time and that I didn't need to explain myself but refocus him ("We want to do this so you get ______."). I was glad I recognized early what was going on because I'm not always self (or situation) aware -- I myself get focused on details at times, meaning the conversation between me and the client. This is something I want to keep working on.

Sunday, May 16, 2010

Don't Want to Get that Excited because of Vacations

In continuation to Self Care -- a coworker of mine has been nudging at me for the past two weeks to go on vacation. You really need it, he kept keeps saying. You've been dealing a lot with very intensive clients. You've been talking to yourself too much at work and it's distracting me. I agree I need a vacation. It's time for a short break and I'm planning on taking a vacation soon. But I also realize it's a short term escape. I come back to similar stresses and difficult situations. I need to focus on improving my working habits to deal with that. Improve on distancing myself from situations so I'm still empathetic with clients but don't take it home with me or don't take disappointments too much to heart. Nothing new to case management universe.

I don't want to look forward so much to a vacation because I still spend a great deal of time at work and want to make it as pleasant as possible. I accept there are slumpier days (or weeks) but I want to continue to learn how to deal with slumpier times not just by exploring hobbies or life outside work but by changing the way I think about work.

I appreciate that I have the luxury of enjoying what I do most of the time. I'm extremely grateful for that. Not to mention all the support I get that I see friends in other agencies not getting. I try to and remind myself to be aware of what I have when I get caught up in frustrated moments. Not saying it's always easy. But I keep trying.

Friday, May 14, 2010

Struggling with Limitations of my Work

So I have a household, a middle aged couple, who's making irresponsible -- constantly irresponsible financial choices. I'm able to give them short term help on occasion (gift card on occasion for example) when they reach out to me once in a while but it feels like it's so little. Harder than that is knowing that it doesn't change anything from the foundation. Because of the nature of my program client participation is voluntary and clients aren't obligated to follow up with us. It's not that expectations aren't developed with some clients nor do we blindly give goods or consistently help clients who only come to us for help with these items. But these expectations are typically made between the client and his case manager.

It's hard to realize the limits of my work. When it almost feels like I'm painting one side of the wall of a house while a another side of it is deteriorating. Ideally case management is holistic, particularly when a client  has a multitude of challenges -- like budgeting, getting health coverage or services, housing concerns. But if the client only wants one service, specifically goods, but isn't necessarily approaching you with an angry or particularly entitled attitude (and thus is more sympathetic), and clearly seems to be struggling it's difficult not to help. As I've written before, it's even more difficult to accept that sometimes the client just doesn't want to work with me on a deeper level (like life skills) and as a case manager I need to both accept that and decide what I am able and willing to offer.

Saturday, May 8, 2010

Duties as Assigned

A few of the unconventional tasks I undertook in my last few years as case manager:

Moving planner
Alongside wedding or party planners, here is another challenging job that who knows, maybe exists and I just don't know about it. A typically a challenging process and that as an agency we don't do but have still found ourselves doing in a larger or smaller capacity when clients were no longer able to stay in their housing.

Accompanying client to Department of Human Services right after he lost his apartment 

Helping client organize her apartment when her hoarding put her in danger of eviction 

Helping partner of a deceased client clean out their shared apartment
Of clothes and some personal effects. The partner kept some items but was moving out of the apartment and wanted to discard a lot of his her partner's paraphernalia. It was a hard task A process that was hard because I had worked closely with her partner. Felt like surreal closure.

Challenge of translating not just words but meaning behind them.

Cable technician 
("Since you're already here, will you take a look at my TV? The cable won't work")
-- Cousin to teaching folks who have never owned a cellphone how to use one.

Putting furniture back together
I have been known to screw a table top back in place.

Feel free to share any unusual tasks you took on as part of your job.

Wednesday, May 5, 2010

When to Close Doors to Participants at Workshop

A coworker and I had a great turn at a scam awareness workshop we ran a few weeks back. Five minutes into the workshop we had 8 participants. We didn't tell reception when to stop sending people and folks kept coming in. We didn't expect even ten people to show up. After an hour and a half 20 participants were in the room with at least five of them coming in after the first hour. The atmosphere was hectic and lively and everyone seemed to enjoy the discussion, information and role play.

On my end, my impression was that with a few more clients we would've passed our capacity to be able to give adequate attention to clients everyone. It would've been too crowded. For some workshops we ask for RSVP -- obviously we didn't for this case (though RSVP is still not the best indicator of how many people show up the day of). The fact I didn't expect that many people affected my lack of mental preparation meant I wasn't mentally prepared for such a large group. My immediate response afterward was: We need to close the doors to participants after a specific time -- again, something we have occasionally (though not consistently) enforced in the past. Or close the door after the first certain # of people come in.

But then I wondered -- do the advantages of allowing people to come in very late exceed the drawbacks? Is it better that a client spend even 20 minutes (of the total hour and a half) and share or learn something rather than him not having had the opportunity to participate? This is a vulnerable population who truly benefits from these educational opportunities. And many folks have legitimate mental or physical health disabilities that affect their punctuality. Am I punishing them by closing the doors 30 minutes into the workshop? Sure, It's not unlikely that we'd offer a workshop like this again, or for that matter another agency would. But in general clients' participation is fickle and there's the advantage of them participating while they're already here. Hmmmm.

Sunday, May 2, 2010

What We Do for Self Care

I walked a lot this weekend. Last week it seemed walking was one of the few activities that succeeded in quieting my mind and invigorating me in some way. I've been getting in the habit of taking a break from work at least once a day to go on a walk. 

Last week was intensive and demanding. I usually don't crave the beginning of the weekend as much as I did a few days ago. I've had a lot of things on my mind and continuing challenges with a few intensive clients. To settle my mind and distress I usually write -- a little on this site and more about personal life elsewhere. That typically clears my mind. Exercise does that in a different way. Talking to a good friend -- especially getting a few minutes to just talk about everything with little censorship -- is great but I start feeling like I don't want to repeat myself and complain too much. Or talk about work too much when I'm outside work.

Sometimes I think I need to mix it up and try new things to relax mentally and physically. I have a feeling walking would always help but I'm not always able to do that.

What do you do to care for yourself?

Saturday, May 1, 2010

Mental Health Patients Support One Another

I found the article Mental Health Patients Turn More to Each Other, from American Psychology Association's PsychPORT website that posts articles from various media sources. This one was published in the Chicago Tribune.

The article discusses mental health support groups run by people with mental health illnesses. This is intriguing to me. Having someone lead a group who's familiar first hand of a patient's experience may likely encourage participants to feel like their experiences are better understood. In turn this would make it easier for them to relate and be receptive to the group's leader. Also, something -- maybe instinctively -- guides me to say that a good deal of healing or support may be found from reaching out to a peer, especially someone sharing a similar challenge or condition. A professional mental health provider seems more removed. On the other hand, I see benefits in having a professional who's trained in theories, therapy, and treatment.

I'd like to learn more about this.