Wednesday, November 16, 2011

Rich People, Poor People All Got Dreams

A line in a song made me think about this. Simple and true. I felt like I hadn't reflected on it in some time.

As I work with my clients day to day we don't often talk about their dreams. More frequently we're dealing with a crisis, navigating benefits programs, or discussing resources for basic needs, like food pantries. Dreams are still there but we're focusing on what needs to get done. Many times this does mean the basics: Benefits stopping, client getting behind on rent, food insecurity, issues with quality of housing.

I do discuss long term plans with clients and these may include aspirations. A common one is finding subsidized housing. Two important steps are usually needed, in some combination, to reach long term goals. Planning and meeting basic needs. It's easier to plan when your situation is fairly stable and this, for a variety of reasons, is challenging for clients who are in situations of ongoing crises or have physical or mental health challenges.

Occasionally a client mentions he wants to complete the GED or college. Learn to play an instrument or a new language. I enjoy having these conversations with clients to understand better what makes them tick and to eventually discuss how they want to pursue them.

Tuesday, October 18, 2011

Let's See that Happen

"Anatolia, I'm going to stop by Empoder. When can I see you?"

I have a couple of prospective clients who occasionally stop me outside of Empoder and 'threaten' to stop by and set up an appointment with me. Each came in and set up an intake appointments with me multiple times and didn't show up. After finding myself in my office, third or fourth time around, wondering where oh where has my resident gone, I realized perhaps it wasn't the right time for them and I to meet.

Finally I said to each, "Let me know when you're ready to see me." It's not that people always make their intake appointments. Some people come in to Empoder and I set up an initial appointment with them and don't see them again. Others miss the first appointment, perhaps even miss two, but after they'll likely follow up fairly quickly (if only for the initial appointment).

With these rare folks it seems they don't want case management services though they get something from our short exchanges. How are you, how's it going. Knowing they have an option for case management in the future.

Friday, September 30, 2011

Explore a Client's Network of Support

Having even just one family member or friend in a person's corner, when that person doesn't have other support, may have make an astounding difference. It may mean a person has a temporary place to stay after she loses her housing. She has help filling out a prescription. Or it may mean just having a listening ear. A mini community. It's good practice. I'll support you and you'll support me.

I want to encourage myself to remember to delve deeper into a client's network of support. Make certain to have this conversation with clients. Sure, sometimes clients have already tapped into their personal network before coming to Empoder but this isn't always the case. Along with family and friends' support are the more formal options. Is the client a veteran? Does she have support specific to her situation? Is she eligible for assistance through mental health resources?

This is for case managers who want to fill in gaps in a client's lack of support and moreso, those who who are tempted to do this a great deal by themselves. Earlier on as a case manager I approached my work like with a few intensive clients. While I did reach out to other providers I learned later in how many situations it would've benefited several clients and myself to reach out for additional support sooner.

I've already spoken about limitations of case managers. Some of us may have a holistic approach but on our own we can't be family, friends, legal, and medical advocates. We're a resource at Empoder. We do provide guidance in regards to life skills and offer support but it is exhausting and professionally not possible (until I get the legal and medical degree in the mail) to do it all.

Also see Struggling with Limitations of My Work

Monday, September 26, 2011

A Few Requests for Home Visits

It's good to do home visits. Suddenly you're in the clients' territory where they're comfortable. You learn a lot from doing home visits, including some things you would not know from only having a client visit you. Like how many people actually live in the apartment. What condition it's in. Glimpse into what their home life looks like. It's a pretty intimate view, really.

I do appreciate clients taking a few steps in making you, the case manager, comfortable.

1. To the question is (wearing) my towel enough ... The answer would be a no.

2. Try and make space for the case manager to sit somewhere. It doesn't have to be furniture if this is an issue, of course. But it's great when there's a clear area to sit.

3. Try not to be surprised when your case manager shows up at the time you had scheduled to meet (also known as I can hear you in there...).

Though I don't expect the following by any means, I'm grateful when a client offers me something to drink. Not sure why -- it's the symbolism of it more than anything.

Thursday, August 25, 2011

Are There Enough Jobs?

If folks who have SSI or SSDI* would all decide they want to work would there be available jobs for all of them?

* SSI/SSDI: Payments from Social Security Administration that people receive due to a disability.

Yes, a very short post for quite a long pause in writing. Moving forward I plan to write 2 posts per month. If I end up posting more, great. But I plan for this to be the minimum.

Saturday, August 13, 2011

Checking in on Goals with Clients

When I start to feel overwhelmed as I think about all the challenges a client is dealing with,* unsure where to begin and what to work on, I think about one thing that makes it easier -- where is the client? What does the client want to work on?

It helps to remind myself that the work is about the client.

As I continue working with the client I check in after a few weeks and ask myself are we still working on the same goals? Originally my client said he wanted to resolve issues with his landlord but now he's talking about moving out. Time to reassess. Is my client changed aim realistic? It's true goals may change. Maybe a client doesn't want to commit to one after all. I found that some of my difficult cases were this way because I was still working on an original goal while my client was working on another. This is one reason why it's important to check in on this on occasion.

Having worked in this field for several years my brain takes what a client is sharing with me during intake or conversation and puts it in categories of issues to address. However, after hearing six different issues my client is dealing with, it's not uncommon that she wants to focus on only one area. It's challenging for me to hold myself from my holistic approach that thinks: Let's rock, let's address all your concerns. But I need to listen deeper to what my client needs through her statements and life situation.

* See earlier this week.

See also: Let's pace this collaboration

Saturday, July 30, 2011

A Secret Client

Sometimes I wonder what it would be like if social services were visited by secret clients, similarly to how secret shoppers assess businesses' quality.* I picture a secret client eyeing me suspiciously, taking notes as I sit with him and fill out the intake forms.

Assessing case managers' services isn't quite like evaluating a business though. At a social service agency, a client isn't receiving a straightforward good like food or hotel accommodations. Also, a case manager/client relationship is ongoing and collaborative, calling for a client's commitment to work on goals. At a certain level case managers have their own style as well.** This influences how well they work with different clients.

Assessing service during intake though is fairly straightforward. How's the case manager approach? Is she working on developing rapport with the client? Treating the client as a person, not as answers to a set of questions? Giving the client time to answer, asking very personal questions sensitively?

Though the secret shopper system may not work in this field this isn't to say case managers can't and shouldn't be assessed on a regular basis. It's only that criteria of doing this is layered due to nature of the job. Typically it's staff evaluating case managers' work, namely supervisors. At Empoder, colleagues offer their insights informally and sometimes even without being asked.

Still, it's valuable to know from the point of view of clients how you're doing your job. Case managers may learn this through confidential surveys from clients. One good indication that you're doing something right may be that majority of your clients come back or follow up.

* For the record, in regards to the concept behind secret shoppers: I don't think the customer is always right.

** Still, it's important within an agency that some uniformity exists in how case managers work with their clients. And clients do talk with each other.

Wednesday, July 27, 2011

Not a Therapist -- When Boundaries Make My Job Easier

A client of mine, Betty, lost a close relative. Betty and I had worked together for a fairly short time but more intensively in the past couple of weeks as the health of the relative she cared for declined.

Betty came in to talk with me and as she sat down she shared the news her relative passed away a day earlier at the hospital. She looked to the side while she talked about some of the details of what happened. I offered my condolences and asked if she wanted to talk with me about how she was feeling and she said no. I answered OK, adding an offer to look into supportive services with her if she'd like in the future, and our conversation turned to working on case management issues. What did she need help with? Burial plans, navigating insurance. Logistics. Betty has a sister but they were on difficult terms and she asked I help mediate between both of them. We did a conference call that went better than anticipated and Betty and her sister made plans to follow up later.

Towards the end of our appointment Betty asked about mental health services. We agreed to follow up to look into different options. After she left I thought that it's sometimes a relief that my job doesn't involve therapy. It may be helpful to focus on one area, particularly when a lot of practical work needs to get done.

It is important to let folks know that support exists beyond case managerial support. Therapy may not be appealing for all but the idea that it's accessible is comforting. Offering support, even in the shape of other agencies that offer more specialized support, also let's the people you're working with know you're thinking about how they may be feeling.

And as important: While it's helpful to review options, it's equally important to let the client lead. What s/he wants to focus on leads the professional collaboration.* This is something I continue and remind myself.

* With some caveats sure, but at its basic level a professional relationship is fruitful when a client's goals align with a case manager's goals.

Saturday, July 16, 2011

Drawback of Stuff Swap Community Events

I was at a stuff swap community gathering a few days ago. For folks not familiar with this idea, people bring items they don't need (hopefully still in usable if not good condition) and take other items for free. Terrific concept. Reuse, recycle. Giving away items you don't need instead of throwing them away. I loved that it was on a larger scale level too, that people who didn't know each other took party in it. I've been to clothes swapping parties before, for example, but with friends.

I couldn't help but think though, while I was perusing the booths, of folks who aren't throwing items away but only adding more. That several people are coming away from the event with more items to apartments already overrun with belongings. I wondered if having a system would be helpful. For example, that for bringing a certain number of items to the event you may take away that same number of items. You bring 6 items and may take up to 6 items home. I wonder if this would help.

Monday, July 4, 2011

Joys of Running a Benefits Program Onsite

My agency hosted a benefits program a couple of weeks ago. Federal reps came in to process the applications and Empoder's job was to advertise the event and mediate traffic the day of the event.

An important conclusion if we choose to do this again: Be as specific as possible when advertising what documentats clients need to bring.



As possible.

Make sure all case managers know so they could review them with their clients. Now, I did make fairly detailed flyers that were fairly detailed and that asked clients bring the most recent copy of their income.

"But Social Security Administration didn't raise disability benefits in the past 2 years so what does it matter?"

The answer is the rules I do not make.* This answer is profoundly less joyous the day of the event.

Though I'm the most detail oriented person in the world even I didn't provide such detail in my written handouts. I know now how I would improve it but on the other hand, no handout covers everything. Even with an organized list of eligibility requirements there are several possible what ifs. What if a person has an expired ID? Or has a rent receipt but not a lease? Or no income this month but will starting from next month but right now her aunt is paying towards household expenses and her cousin isn't really staying with her but for most days out of the month she does da da da da da.

One good thing, it helps to run a benefit's program with familiar clients because some needed paperwork may already be available in a client's file. It's also easier to deescalate a situation when you or another case manager knows the upset person (aka client) who has been waiting for an hour and a half and found she's missing a document.

Important side notes: Keep a clear sign in sheet showing order of people who came in. Also, it certainly helps to check in with waiting clients occasionally and let them know how long wait will be. Or, since it may be hard to assess exact time, estimate how many more people may be seen.

* Technically Social Security Administration is supposed to mail you an awards letter (document that states how much you receive in disability benefits each month) each year but not everyone gets them. Or places them in a memorable place. Or knows what they are exactly.

Thursday, June 30, 2011

Anti Bullying Status Response

I came across Facebook's anti bullying status a few times. Goes along the lines of: "People look down at a girl who has a baby at age 14 not realizing she was raped. People hassle a person who's overweight not knowing his obesity is due to illness."

In other words, don't judge and perhaps more importantly, don't assume. Two values I appreciate though admittedly the judging part, well, I'm working on that in my personal life. Professionally I do a pretty good job of keeping myself in check (and have coworkers who volunteer to do that).

On the other hand, something about this status doesn't quite work. Perhaps it's because a short message may sometimes be misunderstood. Or maybe due to my social work mindset I think, what about...

Let's say there's a 14 year old girl who's pregnant because she had sex with multiple partners without protection. She was trying to get pregnant. Or a person is obese because he eats a lot. Let's say he enjoys it too. Are these folks less deserving of kindness or understanding?

I do get the status' deeper meaning: Don't judge. Presume that people's situation is not as simple as it seems. Yet it also implies that one behavior is more rewarding of compassion than another. Granted we do that all the time -- we make judgments based on context. But it seems to defeat the purpose of this message which is to act compassionately.

Saturday, June 18, 2011

Tuesday, June 14, 2011

Wednesday, June 8, 2011

Apprehension that Things May Get Better

It took me some time to appreciate... An unlikely challenge to achieving a goal: It's scary to think things may get better (more so when it involves making a new healthy or otherwise positive choice). It's scary to step outside a pattern, even if that pattern causes chaos or anxiety. Going through a similar cycle brings a sense of comfort. It may be painful but it's familiar. The idea that things may get better may actually cause anxiety.

I've observed this in clients and others as well as in myself. Apprehension about things improving adds another layer of struggle when trying to work towards a goal. It is funny because it sounds so illogical.Why wouldn't you want something to get better? Yet we are creatures of patterns and years of habit, even the way in which we grew up may set the stage to certain types of behavior. These may be changed but it's not unusual for this to be a process.

I plan to write more about goal setting in a future post.

Wednesday, June 1, 2011

Sometimes I'm Not Sure How to Respond

Sometimes clients make side statements that are difficult to respond to. "Oh, things aren't that bad." No, I'm not going to offer that reply. "I'm sure it'll get better." A platitude helpful with its empty meaning.

What's an example of a difficult side statement? A meaningful comment made, either as an afterthought or matter of fact, like "Don't grow old, Anatolia." A few clients have told me this in a context of illness or challenge that growing older brings. Sometimes these comments are meant in humor but not always. Sure, it may be a comment that could be delved into during a future session but sometimes it is just a passing comment. A client may not want a response too. Yet I have this instinct to want to be reassuring in some way.

I envy case managers who just know what to say and whose responses are genuine. Certainly a skill.

Saturday, May 28, 2011

Advice for New Case Managers

Though I wrote this post a couple of years ago about how advice may have not helped me when I started at Empoder, I changed my mind. I do have advice. Maybe it won't make much sense the first day or week, but at the end, I think knowing this early on helps:

Initially sit in as many appointments between clients and different social workers/case managers in your agency as possible. Each case manager and dynamic may teach you something.

Connect with the client's providers to learn more about the client, coordinate his service plan, and find out what services and (this one's sometimes my favorite) goods he's getting from another agency. Particularly relevant for clients who you'll work with more intensively or clients who ask for a lot of assistance.

Get into the habit of staying organized early. As organized as possible. File papers right away. Trust me.

If you must have post it notes or handwritten notes for a short time, and these should be sparse, date them. Date them all. It may be helpful to have a notebook to keep info in one place.

If you're not able to help a client with an item (like a dresser) always give another option. Like offering to budget with her to save money to get one or refer her to a resource that may help.

Make sure you're able to read the doctor's handwriting (on prescription) before you leave her office.

Find support in a coworker or professional in your agency or field. If you're unable to find support this way, be open to seeing a therapist. This gig is difficult enough with support.

Please feel free to share your suggestions.

Tuesday, May 24, 2011

Refocusing Speaker Also Needed

Workshop at Empoder. 45 minutes in. The speaker still has quite a bit to go through in her presentation about legal rights to do with immigration and a client rises his hand and starts going into a very detailed and specific question. The kind that has an answer that would really only be relevant to him. I speak up after the question goes into minute 3 of explanation and say: "I'm so sorry to interrupt but we have a lot to cover and I'm sure the speaker could answer individual questions later." Speaker speaks up and says "No, it's OK" and nods for guest to continue. Aaaaah, I'm trying to help you here speaker! And the rest of us who want to get all the information you were planning to share with us before allotted time is up...

Saturday, May 21, 2011

Let's Pace this Collaboration

I'm not going to get it all done in a few meetings. Surprise! Yet it took me a long while to truly accept this. I won't be able to resolve 5 issues (may no be able to resolve one if it's complex) a client is dealing with in two sessions.

Some issues are straightforward. People just need help filling out redetermination forms for food stamps. Easy. A referral for a dentist in your neighborhood? OK, well you have Medicaid, so yes, it may take time but we could find a few dentist options. Yet some situations need more than one session to solve. A client gets behind on rent again due to money mismanagement. A client doesn't follow through on referrals yet comes back and says she still needs help. There's a larger issue here and it relates to the client's behavior and choices.

It's unlikely that after decades and decades of habits and lifestyle a client's behavior will change immensely thus guiding us to collaborate smoothly, at the end each of us skipping along on her merry way.

How can I expect people to change their lifestyle quickly when I see how in myself and people close to me that this is difficult to do? This bearing in mind that I and many of my loved ones grew up in a stable household and supportive environment.

Client's established behavior is not the only reason issues take time to resolve. Bureaucracy is part of it. Lack of resources, like when a client asks me about a legal matter but his income is just above the limit for free legal advice. Providers may not be reliable. It's tough being the mediating party between the client and a targeted service.

Not to mention also that clients may not necessarily come to a case manager with one issue. Three or four is not uncommon and each may be related to the other one in some way. Untangling each and working with it independently may be challenging as well. Like, perhaps if a client received mental health services other issues would be easier to deal with. It may not always be quite that simple but sometimes tackling one overarching issue paves the way for dealing with other challenges.

Pacing is crucial when you have a caseload of 40-50 people. Even back when I had a caseload of 30 people I would be quick to schedule a follow up appointment in a week's time even when an issue could wait. I prioritize much better now which gives me a bit more space to breathe. I also continue being better in encouraging clients to try advocating for themselves (perhaps with some coaching) before I step in.

Pacing is something I need to keep working on. I think I need to start thinking realistically about what I may accomplish in a week. There's a set amount of time to work with and typically a few surprises (in varying shades of crises) that come up as well.

Friday, May 13, 2011

Financial Crisis Readings

In my search for some light reading I started researching information about USA's financial crisis. Though I stay pretty updated with what's happening now I wanted to understand its roots better.

As a side note, I strongly believe all case managers and social workers should have a fundamental understanding of economics. Frankly, it benefits us all to understand it as well as causes of financial crisis in educating ourselves on viable solutions.

During my search I came across this video:

Crisis of Credit Visualized

Indeed gives a pretty clear explanation. But were the causes this straightforward? Lending money to folks to buy a house when they weren't realistically going to be able to make payments was certainly irresponsible and unsustainable. But was something else at play? I'm usually not quick to believe simple explanations.

A friend recommended I listen to American Life which I had a chance to peruse a little and I recommend it. Here are two particular shows I enjoyed:

The Giant Pool of Money -- Housing Crisis and its Relation to Financial Crisis

Collapse of Banking System

I'm not saying they give all the answers but they do give food for thought.

As for readings: Through New York Times I found a link to Books for Understanding. That site links to a list of books and academic papers examining financial crisis. Gonna take some time to wade through this list. If you have any recommendations or thoughts about this topic please share. To be continued.

Monday, May 9, 2011

Now I need to Advocate for Myself.. Hold Up..

It's going to be easy for me to plead, speak assertively, and demand to speak to a supervisor if my insurance issue doesn't get resolved/apartment maintenance issue isn't dealt with (OK fine, that one doesn't involve a supervisor exactly). I do that every other day with a client. I'm ready to go!!

Hmmm. It's not quite the same to advocate for myself though. It feels challenging (though it depends on how complicated the issue is as well). Not because I don't think I'm deserving of fair treatment. Somehow it's easier to do if I imagine I'm doing it for someone else. Perhaps in a similar way to it being difficult to ask for a promotion for myself. Maybe also because in case manager mode I speak with certain authority that's good to apply in some personal situations as well..

Monday, May 2, 2011

9 Phrases from Clients that Illicit a Long Inward Sigh

1. "You look shorter/wider/more perpendicular today."

2. "I mailed out the original and only copy I had of my birth certificate/receipts/some document that took us 6 months to obtain."

3. "What else you (Empoder) got?" (Meaning, items/goods. Gift cards? A dresser under my desk perhaps?)

4. "I lost my check--"

5. "I won $15,000,000 in the lottery and all I had to do was pay $100 to take part in it!"*

6. (Exasperated) "I've been trying to reach you for two days!! You didn't return my call!"

7. "Want to hear a (joke that I will soon find out is inappropriate for some reason or other)?" Granted, at the end of which I may want to sigh or make a brave attempt not to laugh.

8. Leaving a doctor's office with client, client says "I wanted to tell Dr. Adams that I _______________________. You don't think that was important do you?"

I will be quick to admit I've certainly been in that situation before with my own doctors.

9. "Yeah, (provider's rep) said he was going to get this done!! I don't know, his name was Steve or Barry, something like that."

* I hate scams.

Also see

Saturday, April 23, 2011

Photos of Elderly Animals

I was intrigued when I came across an article sharing photographer Isa Leshko's photos of elderly animals or animals at the end of their lives. I was intrigued by this project and the concept behind it. It's absolutely true that photos of ducklings, puppies, and baby ferrets are found all over as well as animals in their prime, as Leshko states. I liked the spotlight being turned on elderly animals. Her photos are touching and I get a sense of gentleness through them.

The back-story of the project: Leshko cared for her mom, who has Alzheimer's disease, for a year. She started taking the photos as a way of dealing with her feelings from that time.

More photos may be found on her site.

Wednesday, April 20, 2011

Pattern in Dynamics with Another Person

Me: "All right, so you're emailing me the document????"
Provider: "Yes, I'll do that right now!!!!"
Me: "All right thanks!!!"
Provider: "Sure. You're welcome!!!"

So went the last exchanges in a rather frenzied conversation with another provider. It was a positive interaction, and the fellow case worker helped in solving my client's quandary, but both he and I spoke in a tone that could best be described as stress!!!!! I could hear how the provider on the other end was already thinking of the next task he needed to take care of at the end of our conversation.

This got me thinking about how we respond to other providers or clients, particularly once there's an established relationship. We develop a dynamic with each person we meet and with each new relationship a pattern develops. We expect client A to resist our suggestions or look forward to client B's enthusiasm to tackle a challenge. Which means that from the beginning of our appointment my attitude with client A is going to be more guarded but I'm also going to expect that the session to be difficult which in turn may very well mean a difficult exchange. We do like patterns as people but sometimes they work against us.

Saturday, April 16, 2011

Sister Souljah and No Disrespect

One day, fairly early in my job at Empoder, I was leafing through the autobiographies section in the library and picked out No Disrespect by Sister Souljah. I wasn't familiar with the author but the title grabbed me. I read it half of it that night, captivated by her. Sister Souljah shares some background of her childhood, college experience, and life after graduation. As she enters college the focus of the book becomes her romantic relationships but throughout themes of race and racial injustice stand out.

Her strong persona intrigued me and more so, her perceptions on race and racial dynamics made me think a lot. My first reaction was defensive; "She comes off as someone who hates all white people. How can she mark off a people because of their color? Isn’t she doing what white racists do?" This came as a reaction to Souljah’s strong views on whites. In the entire book she didn’t share one positive experience with a white person. White teachers (as well as Jewish teachers) didn't encourage her intellect and she had to fight for every scholarship she received. Later, in college, the one white woman who stands up to her opinions on whites, talking about those who wanting to work together with minorities towards equality, is highlighted in a scene that further brings out Souljah’s disdain for white people.

As a sidenote, I didn’t grow up in the US. I studied US history in respect to racial relations, from slavery to segregation laws to civil rights movement but learned much more after moving here. Souljah’s book threw the volatility of racial relations in my face. Her writing came across as accusatory and holding nothing back. While I was able to understand her anger, what really shook me was how vehemently Souljah seemed to feel about whites, those in power and those not, seemingly clumping them all together. As a case manager who worked with dedication with people of all backgrounds this was hard for me as well.

I thought out loud to a friend about how I didn’t understand why Souljah's view on white people were so sweepingly negative. I don't remember her answer but I remember it made me snap out of it. I was taking Sister Souljah's message personally -- as a personal attack. I was reacting to it emotionally. What Souljah was sharing was a feeling of deep injustice. Maybe I wasn't able to fully understand it, having not come from a similar background, maybe even after understanding it I didn't agree with her on everything she wrote, but it wasn't about me. It was about her growing up in a tough life, fighting for everything she had, and feeling angry she had to fight so hard for it. It was about the system of inequality, in the US and globally. And presenting her views without holding back, without gently probing the topic or tip toeing around it.

Though at times she came across as arrogant she wasn't afraid to share deeply personal experiences concerning her relationships with other men and family and her writing was engaging. Following this book I would go on to read other books and essays about poverty, inequality, and so on but I appreciate I read a take no prisoners book early on. It's good to read books that remind me that it's not about me and as good to read something that is going to be challenging.

5/2/2011 To clarify: Sister Souljah (who I've seen in interviews and read beyond No Disrespect) has indeed shared views I disagree with. My point was to readers who may have had an initial reaction like myself, to encourage them to look beyond Souljah's statements that are wholly negative (i.e. her expressions that generalize white people) and not get distracted by them, but instead to focus on examining the actual system that Souljah is criticizing.

Tuesday, April 12, 2011

How My Job Has Influenced Some of My Perceptions

I was sitting on the bus today when a gentleman walked by on the aisle and his body odor was really strong. I suspected he was experiencing homelessness. A few people reacted to him. Conversation carried on. I thought for a moment about my own reaction. How has that reaction changed since I started working as a case manager several years ago?

At that time I would've likely reacted with a mixture of sympathy and aversion. I would've maybe thought a bit about where the person came from, his background, how he grew up, but it would've felt quite disattached from myself. After working as a case manager for some time and getting to know people of various hardships, housingwise, physical, mental, fixed (disability benefits) or no income, I was able to appreciate the depth, the story behind a person with these challenges. Through the years I also learned much more about the system, encompassing social reform in US, Medicaid, Medicare, disability, inequality in its various forms, and am still learning more.

I come from a privileged background. I realize what I wrote above may read for this to be the case. I grew up befriending people from different cultures and incomes but led a sheltered life in many ways. I felt the love from my parents and grew up in a stable household. I developed values that, left unchecked, are projected onto clients. I need to remind myself to carefully consider where clients are coming from.

My job hasn't changed some things. While I absolutely believe the system needs work and impending budget cuts (to programs related to health, housing, educational, should I go on?) concern me deeply I too believe in people's capabilities of being involved in some way in their community if they're unable to work*. Or even in doing something positive for themselves, learning their rights and obligations, developing skills to advocate for themselves, teaching other people skills. And on another end of it having a hobby, exercising, taking a class. People need to take ownership of their lives but as a society we do well to support one another (not to mention we don't all start off on equal footing, but that's for another discussion). And I suppose these values I learned from my parents and immediate community.

Yet, considering the magnitude of the impending cuts they do limit people's abilities to take actions that promotes their wellbeing. Severely cutting programs that serve people with low incomes, people with disabilities, and still expecting them to function as well in society does not sound right.

* Unable to work meaning they have a disability for which they receive benefits

Saturday, April 2, 2011

I'd like a New Case Manager

I had been at Empoder for 6 months when a client responded to my department's decision to deny her financial assistance by asking to get a new case manager. It was the first time I heard that request (request, demand) from a client. Though all financial decisions are made by the department's team they're delivered by the primary case manager. I had worked with the client for a month and met a few times which didn't help develop a strong rapport between us. I tried to suggest other options but my client was adamant. She wanted a new case manager. The truth was I wasn't really interested in continuing to work with her. I was annoyed by what I felt was her sense of entitlement and brash attitude with me. I responded that my supervisor would call her to follow up. Later, after speaking with Feona, my supervisor, I realized it would've been better that I referred my client to talk to Feona directly since she initiated that request.

Typically once clients work with a case manager at Empoder they'll continue to work with that person. Rarely do transfers to other case managers occur. When they do usually it's with newer clients or on a case by case basis where both case manager and client find it difficult to work together but there's still reason for the client to continue and receive services. It's also not unusual for case managers to collaborate on particularly intensive clients.

If I could talk to myself at that moment, six months into the job, I would tell myself that just because someone requests a new case manager it doesn't mean by itself that I'm not doing a good job.* I'd also tell myself (after I calmed down) to remember where clients are coming from in terms of their own difficulties, challenges, and lives before they walked in my office. Not to mention the need to not personalize other clients' anger or negative emotions when directed at me, something that would take me a while to fully learn and hey, something I still need to remind myself.

It's not necessarily unusual for case manager/client relationships to have ups and downs but ultimately they succeed for similar reasons. Rapport is essential for a good professional relationship. This is based on mutual trust, respect and something intangible. I add the intangibility factor because sometimes a case manager and client don't click and it's not necessarily something that may be anticipated.

A general request that my department honors is a potential client's initial request to work with a man or a woman. Matching client and a case manager based on this preference may set better grounds for a comfortable and trusting relationship. To a degree it helps that case managers' expertise be taken into account when matched with new clients. For example, case managers with more experience with people with severe mental illnesses may work more effectively with a person with schizophrenia as opposed to a CM without this experience. On the other hand, a case manager's work at my department is superficial compared to therapy work. We're not clinicians or therapists. Our job is often to refer and mediate, connecting clients with services they need, navigating health or benefits systems with them. It helps to have experience with a certain segment of the population but if that's not there, it's possible to work to connect with another person through respectful, empathetic, and patient approach. More so than possible -- it's necessary. Taking part in mental health (and crisis, motivational interviewing, and so on) trainings, which we all should do as case managers, should complement this approach.

* Regardless of an incident like this it's important to continue and reassess how you work, your skills and effectiveness as a case manager. For the sake of this post I didn't delve into this.

Tuesday, March 29, 2011

Continuously Reassessing Clients' Capabilities

My inclination as a case manager traditionally was to more quickly offer a client support in regards to advocacy (rather than encourage her to try first on her own). This was particularly true with clients who I initially assessed as needing more support because they had a developmental disability or rather debilitating mental illness.

Though I always considered it a good part of my work to promote empowerment, initially I considered empowerment in narrow terms: Encouraging my clients to join the workforce or become involved in their community (through volunteering for example). Educating clients about their rights and benefits was certainly part of empowerment but sometimes it was easier to make the call for the client. Reaching out to a provider as a case manager sometimes yielded quicker responses. Particularly when it came to time sensitive issues this helped.

I don't even think I was quicker to offer to make a call for the client because I'm particularly nurturing or because it was part of my job but because I wanted to work hard for the people I work with. Yet that's not what social work is ultimately about. I've gotten much better at being aware and reminding myself that it's important to continue and assess a client's ability to perform certain tasks on their own. To be more inclined to offer a client to first make a call herself and let me know how it goes. This may still include educating a client on her rights/benefits if she isn't aware of them but giving her tools to advocate for herself.

Sunday, March 20, 2011

Pondering Case Management Services Being Done through Email

Every once in a while, usually right after getting a quick response to an email I sent a provider, I think about how great it would be to communicate more through email. To share an update on a client's situation, easily change an appointment time, remind a provider that yes, I still exist and am still waiting on his answer. No need to be on hold for 15 minutes to be told that the person I'm looking for is actually not working today. Not to mention avoid playing the phone tag game where communication is only being done through voice mail. Some clients, though for me it's more of a rarity, prefer to communicate through email rather than by phone when we're not meeting face to face. Emailing may mean being able to respond to their questions more quickly.

Emailing brings its own issues though. Like emailing back and forth and after round 4 realizing that even though I thought I was being very clear in my email my question is still not being answered. Or while carefully writing paragraph updating a provider of what took place with the client I think how I could easily explain all of this in two minutes over a phone conversation.

The meaning of an email message may be misunderstood. An email's tone may be misread. That's why at times I'm very careful in my wording in emails (particularly when it comes to correspondences with clients), going as far as asking a staff member to look over a specific message to make sure what I'm trying to say is what's coming across. Unlike a phone call, a reader has more time to reread the same statement without being able to easily ask for clarification or respond as easily as in a phone call. From experience, I generally avoid e-mail correspondences with clients unless it's to share resources or general information.

At the end too, the expectation I have that a provider will be able to respond to me quickly (more quickly than a phone call) is similar to her expectation that I'll do the same -- not to mention a client's expectation that I'll answer her question quickly. With some emails it's easier to respond quickly than others, not to mention the other tasks that need to get done for the day outside the email universe.

Monday, March 14, 2011

Case Management Personified

A while back Nechakogel posed an intriguing question about what characters social workers see themselves as. What cartoon character or image closely resembled my approach to case management I thought... The first image I thought of was a dam. Clients keep coming, I'm dealing with tough cases, people with harsh histories or circumstances, crises hit, and I need to stay grounded and strong. In control.

And then on some tough days I feel more like the sorcerer's apprentice after a spell gone awry, trying to stop the metaphorical brooms from pouring more water after the room's already flooding. 

When I considered these images along with other cartoon characters, though, I found them mostly limiting because they didn't represent the interactions or relationships I have with clients nor their own strengths, efforts, and struggle. Though I see my work from my perspective to a degree, the work and goals are to a greater deal the clients' goals.* Not to mention, well, picturing myself as a dam? No one person is a dam. (Why did no one tell me I couldn't just do it all alone? Or maybe I just didn't listen...)

After thinking about it more I saw similarities between my case management role and an aspect of Aladdin's Genie. Picture the scene after Aladdin has been transformed into Prince Ali. Genie mingles in the crowd, once talking as a child and once as an adult, speaking with a different accent or talking positively about one of Ali's attributes that would appeal to his listener. In short, using different ways to smoothly connect with whoever he's talking to. To a degree I do this as well, adjusting a little depending on who I talk to. I do this outside of my case management job, but at work it's a particularly valuable skill. The way I talk and approach collaborating with a client with a developmental disbaility is not how I approach a client with schizophrenia. And good rapport helps sustain a good working relationship.

* It's a collaboration sure, but I remember the last time my goals for my client weren't the same as his goals. Ask me how it worked out.

Wednesday, March 9, 2011

Psychiatry More Focused on Drug Therapy than Talk Therapy

Admittedly, this New York Times article wasn't an all out surprising read. From my personal experience I understood that after the initial intake psychiatrists meet for a short time with patients to get a quick update and prescribe/adjust medication. It's with psychologists that patients have an opportunity to discuss and process more at length what's on their mind.

I didn't know talk therapy played quite a larger role in psychiatric services in the past. Interesting (there's a word) too to learn how insurance influences way providers offer care.

Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy.

Wednesday, March 2, 2011

Bias of I Know What it Feels Like, I've Been There

I was discussing with another case manager how some workers in recovery fields* share the same experiences as their clients. An example is a survivor of sexual assault pursuing a career supporting fellow survivors. In terms of a case manager's approach and work with his client, how would it be beneficial and a hindrance if they share a similar experience?

We considered the appeal of this field to these case managers: An interest in reaching out to other people who went through a similar struggle or trauma. Perhaps give back after they got help themselves.

I expect that having gone through a similar experience it may add a layer of sensitivity or a deeper level of understanding of the trauma or healing process. Sure, each person reacts to trauma or addiction differently, but many people who go through similar experiences share similar struggles and emotions. A person who quit drinking after years of struggle may understand and empathize with the difficulties of overcoming an addiction very well.

It may be bonding or inspiring for a client to know a case manager shares his experience but the latter wouldn't necessarily disclose this to his client.

On the other hand, having had a specific experience a worker may be biased and expect to see the same reactions in other people as she herself experienced. This may lead her to fail to acknowledge or entertain a different reaction or client's choice than what she herself made.

Is a case manager less effective in working with a survivor of trauma or addiction if she herself hasn't shared that experience? I don't think so. A professional must learn the theories behind trauma/addiction and treatment (and continue to read up on this as new research comes out) to learn how to effectively work with a client. Experience with clients sharpen a professional's ability to work effectively with them. Patience and an attitude towards working together with the client are more important components of an effective professional relationship than sharing a common background.

What do you think?

* Recovery is how I can best describe people dealing with trauma, grief, sexual/violent assualt, substance/alcohol abuse.

Wednesday, February 23, 2011

Awareness of Poverty over Three Centuries

I'm intrigued by how society's approach to poverty has changed over time. This article gives a brief overview of change over the past 300 years. It does seem to focus more on change in Western countries (Europe and US) and is fairly short but offers some noteworthy insights.

Awareness of Poverty Over Three Centuries

Saturday, February 19, 2011

Therapy Becomes a Real Option

In the past, through tougher personal times, the means with which I handled these issues didn't really include an option of seeing a therapist. Pride and a need to be self sufficient drove me to believe that I should be able to ultimately handle issues on my own. That if I have a problem (something fairly ongoing, that's consistent and weighs heavy on my mind, or an emotional issue) that I talk to my closest support network about it, write out my thoughts on paper, ruminate a little and ultimately get over it. Typically this worked for me.

Recently though this hasn't been enough. I tried some new techniques. I kept seeing the advice of breathing deeply and it's good advice. It helped. I wanted to pursue meditation (of the guided variety). But I'm thinking I would get more support with additional guidance from a therapist.

I understand that there's no shame in asking for help and it's not like I don't look for it in friends or family. But for me the step between this and seeking a therapist was something that I hadn't considered as a real option. It's a humbling place to be in. But therapy is something I'm now actively working on getting.

If you're reading this and relating to how I feel, follow your instincts and find more support. I do realize each person gets to this place on his/her own pace, but I'd like to encourage you to get the support you need.

Tuesday, February 15, 2011

I Called You Two Days Ago!

Says a client with a tone that denotes sheer surprise that I'm only now returning her call. However could one wait two days for a case manager to call her back???????*

Man, I would love providers to call me back that quickly -- and right now I'm talking about providers returning calls for issues I'm having, not relating to a client.

* And yes, to be clear, this instance was a non emergency call. 

Sunday, February 13, 2011

Social Workers with Family Lives I Commend You

All right so we all have a personal lives with their string of obligations but nevertheless, I'd like to give out an acknowledgement to social workers and case managers who have family lives. The women and men who give and work hard at their day (or night) jobs and come home to their family commitments, their kids and/or spouses/family members they take care of. Sure, ideally it's a rewarding relationship but it's demanding as well. And certainly many life situations bring their own set of challenges, but in this case I was thinking specifically about social workers with families.

Here are a few social work online journals I follow of writers with families (I suspect there quite a few I follow who live with their immediate families but don't share this on their website):

Amy at Amy's Life in Brief
Btrflygl at Social Worker Mom
A Shameless Agitator's Inner Dialogue

Go here to see more online journals I follow. I plan to continue and expand my list of blogs I follow in future posts.

Sunday, February 6, 2011

You're Not Alone: Collaborating with Other Providers

..... Settle yourself in your seat fellow provider, this is going to be a hell of a ride. I'm glad to have you working with me on this case. Let's see what we can do with and for this client...

I don't always collaborate with clients' providers as there isn't frequently a need to. During intakes we do ask new clients if they're involved with other agencies. Typically clients share this information and if they don't it'll often come up if I continue meeting regularly with a client.

Even when I have the other agencies' info I don't necessarily contact them. To contact the provider a release is needed of course -- the client needs to give permission for me to contact the agency on his behalf. Really it would be beneficial to discuss the care a client receives with another provider if only to understand the other services she's getting, get her insights as to her impressions of the client and their work together and coordinate basic care. This is particularly useful for clients who need more care. Clients who need short term and specific help (applying for a specific benefits program) don't necessarily require a call to another provider. 

Providers do fill in gaps for each other and what can I say, I appreciate it. I apply for this benefits program with a client, while a case manager in another agency advocates on the same client's behalf in physical health issues. I advocate in in one area while my client receives mental health counseling from her provider because I'm not a clinician.

Several situations call for me to contact another provider. If I'm working intensively with a client on one issue and know other agencies are involved it helps to discuss and coordinate her care with another provider when I know she's getting similar advocacy work elsewhere. Maybe another provider has a direct link with public aid office (which Empoder doesn't) so he can focus on working out an issue client has with his medical coverage while I could focus on another area. If a client's asking for help with goods on a regular basis it helps to know if she has received similar assistance from another agency. Sometimes this is the case, sometimes not, but it's good to find this out.

While I work with three coworkers in my department we usually don't work with clients as a team unless it's a particularly intensive client. When our team isn't enough, we look to (or for, if a client doesn't have another resource) another social service agency to cover a need we can't meet. 

Wednesday, February 2, 2011

Exercising Different Parts of Your Brain

Sophia Dembling of Real World Research wrote this cool article intriguingly called What is the opposite of writing?

I liked the idea of thinking about what would  that opposite would be. I also appreciated her encouragement to take part in a breadth of activities to stimulate the mind or body in different ways. This is a great way to deal with the stunted or bored feeling a lot of us feel every once in a while. Our minds are looking to continue and grow. Writing, dancing, learning a language, playing the trombone, all work another creative side of ourselves. Developing a breadth of interests is something I'd like to continue to work on.

I recommend this site. I enjoy that it examines research and how it relates to the mind and human behavior -- psychology.

Saturday, January 29, 2011

You Don't Always Work in Something You Like, Then What?

I was leafing through this health focused newspaper and came across an article that included a long list of tips to help the reader "stay healthy while working". Didn't really relate to some of them...

Side note to share my small but noteworthy annoyance at the overstated 'Remember, the customer is always right'... Customer service is certainly important and appreciated, but no, the customer is not always right. And I don't even have much experience working in customer service -- unless one considers case management to a degree to include this -- just empathy to workers and their challenges in working with the public. Maybe the wording should be changed to something like "suck it up" so meaning is more clear.

One particular tip that annoyed me was Ask yourself if you like your job. If you don't change it. OK, apart from folks who don't have many alternatives due to lack of options in their field, lack of transferable skills (to different work), limited education or experience. Sure, theoretically people have the option of going back to school to advance their education but for several reasons, including having kids or being a certain age this may be very difficult to do for many people. Bottom line is for a good number of people their job is what they have for a good number of years. Then what? The answer to this is more useful if a little grittier.*

And OK, maybe you could say, consider the target audience for this article: people who have more opportunities and luxury of pursuing a more fulfilling job. Yet even with a college degree a lot of people work in full time jobs that aren't their passion nor as particularly stimulating as they'd like.

So how would I answer the question to 'then what'? Depends on the person. There's an option of finding something else outside work to make one more satisfied, and/or make the most of work, learn new skills if possible, broaden a network of support through making and developing connections with coworkers, learn your rights as an employee and talk with others about this. And still, I appreciate it's not as simple as that for some people.

I think I prefer the grittier answers than neat lists. Unless they're funny lists.

* Grittier than the simple and appealing "there's always another job out there and there's always an option for you to do something you love."

Thursday, January 20, 2011

It's The Follow Up Dance!

And... You take a client's hand, you take a step back, client walks off, you dosey do around your coworker and woooop and you lost sight of client. Where did she go? You got a call back from the her public aid case worker and you have the information she was asking about. Client's phone is disconnected....

It's not that clients don't fall off the radar on occasion. Since clients seek case management services voluntarily at Empoder it's not necessarily expected they'll come back after an intake or even a couple of visits. Two disconnects may occur on a client's initiative. In one it's with a client while you're working together to resolve an issue he's dealing with. In this case it's hard for me not to be able to see the problem through to some resolution. The second type of client distancing herself is when, after a relationship and ongoing regular contact is established with a client, she suddenly distances herself for an extended period of time (over a month). In this second case*, particularly with clients we've worked with for some time, we do try to check in with them (by phone, letter, or home visits) which is something I like about the program.

No doubt, I understand the many situations where a client was dealing with an issue and was able to resolve it herself or with the help of someone else -- I just want to know what happened and how it was resolved. To be sure I've accepted that I may very well not get this sometimes. Or -- I'll get a call in eight months time asking to follow up on that "situation we had talked about..."

* Though this is often done to a degree in the first case scenario too.

Sunday, January 16, 2011

Hoarding As its Own Disorder in Upcoming DSM?

According to DSM-IV published in 2000, compulsive hoarding is included under the umbrella of obsessive compulsive disorder and not as its own condition. Could this change?

For more on hoarding:

Saturday, January 8, 2011

Recognizing Person Has Mental Illness by Looking at Him?

Ian, a fellow case manager, told me that he's able to distinguish whether a person he encounters casually on the street has mental illness, specifically schizophrenia. He said he did this by observing another person's "way," including mannerism, behavior, and facial expressions. Not a politically correct statement, no doubt, but one that at its core is not different from what we all do when we meet new people. We make quick assumptions and impressions based on general shortcuts and personal experiences. I also don't think Ian was touting professional or magical abilities but spoke from a place of confidence that through his years of intensively working with a particular population that he was well versed in recognizing this condition in strangers. Yet was there deeper merit to what he was saying?

I considered how I myself (and how early) develop a belief a client may be mentally unstable/have a condition of mental illness.* I do this through verbal interactions with a client and sometimes suspect he's mentally ill from our intake (first) appointment. Typically this is because I'm unable to have a logical conversation with him or he shares delusional beliefs with me. His mannerisms and affect are involved too but what he chooses to share and how he shares it are important factors I rely on.

What about other conditions though? It's possible to detect some on a short encounter, like whether a person is drunk or developmentally disabled. This is especially the case if one is familiar with people who have similar conditions. On the other hand, it's not difficult to make mistakes when assessing a person's behavior and facial expressions in a few or even several seconds. I haven't seen studies that explore length of time in regards to correctly assessing mental illness but it doesn't seem like it'd be possible to accurately assess a person's sobriety or whether she's developmentally disabled without observing her for a longer period of time (1-2 minutes) or having a short conversation with her.

In Ian's case, I'd also predict that the fact he works almost exclusively with people with schizophrenia means that he's primed to find this illness, whether in a person who has mental illness or not. I may understand why he'd be more sensitive in recognizing this condition but not sure if he'd be able to do it with higher accuracy than a non provider. I'd expect though that he'd have a deeper understanding of what the condition means.

Because I couldn't help myself: Of course this could start a whole conversation of DSM IV and how mental illnesses are assessed (clinically) in the first place but that's for a whole other discussion...

* A reminder that I don't have a clinical background and so don't have credentials to assess mental illness.

Monday, January 3, 2011

It Doesn't Mean You Have to Like it

While watching Indiana Jones and the Last Crusade as a kid one line struck me. It bugged me because I didn't get it. Young Indiana's trying to get a valuable artifact ("it belongs in a museum!!!") from , if memory serves correctly, a band of men who plan to sell it to the highest bidder. After giving it a good fight, the item ends up on the other side and the men's leader smiles at Indiana and says, either with some degree of respect or humoring him, "You lost today kid. It doesn't mean you have to like it." My initial thought was: Course he's not going to like losing, who likes losing? Certainly not me.

There's depth to the simplicity of this statement, I eventually appreciated. Losses or painful situations tend to happen with some regularity in virtually each person's life. Not talking about the feeling I get when all the good seats are taken at a theater by the time I show up (as paining as it is), but something seriously affecting one's or a dear one's health, life situation, and so on. 

And it's OK that we don't like them. It's OK that we're upset or annoyed and have negative feelings and it's something that maybe as a young person it may feel confusing to go through. I'd need to brush up on my developmental psychology as to when the following happens exactly, but at some point people develop a sense that the world is a just place and that good things happen to people who do good whereas the opposite is true (let's put aside for a moment the occasional subjectivity in what constitutes good and evil). Realizing that good is not necessarily rewarded accordingly is infuriating.*

Months ago a coworker was sharing a rough situation with me in how she was helping to care for an aging aunt. We talked for a few minutes and she shrugged, saying coldly, "But what can I say, that's the way it  is [her aunt's situation]." I said, "Yeah, but it doesn't mean you have to like it," and she smiled. Perhaps somewhat oddly, a comforting statement.

Like anything sure, it can go to the extreme. I don't mean it's helpful to continue and wallow and not be able to work through a slump that's preventing you from taking part in things that make you happy, from working through a crisis or moving on and all that. It may be something that kicks you in the direction of doing something to change things. Or it may just be something that needs to be worked through -- and something that tests our idea that the world is balanced. 

It's interesting -- though I studied psychology in college and in the back of my mind I recognize absurdity behind a lot of things that happen I want to believe I live in a balanced, or just (however seemingly slanted) world.

* I'm not sure if this is similar to the just world effect, by which people believe the world's inherently just and if something bad happens to someone it's because it's his own fault, thus blaming the victim. 

Sunday, January 2, 2011

Social Work Blog Carnival's Rolling in

I wanted to help spread the word about Gord Cummings' (from Functional Assessment) cool initiative to start a Social Work Blog Carnival amongst social workers and workers in helping professions. Hop over to his site to read more details.

Happy New Year wishes all around. Let's get on with it.