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.