Cancellations

We all have those days when we are just hoping and praying that a client will cancel.  Maybe so we can catch up on notes, actually get a chance to eat lunch or go to the bathroom, or maybe because we are just not up for dealing with a certain issue or problem that day.

On the other hand, there are days like the one I'm having today when no one shows up and you're wondering

https://i.chzbgr.com/maxW500/3416319744/hAF5A126B/

b.i.d.

Me: Do you have any medical or physical health problems?
Client: None
Me: Do you take any medications?
Client: Oh yeah, Metformin, Adalat for my blood pressure, Clonazepam, and one for my cholesterol...

With wee little petri dishes, and tiny test tubes...

line from hospital records...

"There have been little laboratory investigations performed."

I'm picturing something like this:

Sending out an SMS

I have been supporting a client for the past month and a half exclusively by text message.  Has anyone else done this sort of thing?  Usually we would discharge a client if we went more than 30 days or so without face to face contact, but in this case the client is at a high risk for suicide, so we wanted to try and stay connected any way we could.

And it seems to be paying off.  He finally consented yesterday to go to a hospital - not just any hospital mind you, but one hospital in particular, in the next city.  If we could send him in a taxi (not something we normally do) and if I could guarantee that they would admit him, and guarantee they would be "better" than the other hospitals in our area.  I told him no way I could do that, but I did get approval to send the taxi.

I'm glad I did.  The admitting psychiatrist actually called me this morning to get some history and let me know my client would be admitted.  This is unprecedented!  Last time I sent out the local Mobile Crisis team and they took him to our local hospital, they had discharged him before I even got back to work in the morning!  I know there are lots of reasons this may have happened, but it's still very frustrating and also compromised my therapeutic relationship with the client.  It's so rare that hospitals follow up with us in this way.  The psych even stated that he could see this client needs long term care more than a hospital stay, but was willing to admit him in hopes that we can facilitate that while he's in.

I love when things work out this way.  It remains to be seen of course what will come next with this client, but so far so good.  And after I worried that my texts were just floating in the abyss, probably not affecting him at all.  It's still not my favourite way to practice, but just goes to show any connection is better than no connection.

What a great start to my long weekend, happy summer everyone!

Top Fashion Prize

for the day goes to the client who came in wearing the bright yellow t-shirt that reads

I'M WELL ADJUSTED

x10 000 000 points!

Overheard clients in the hallway

I always go to my shrink, but I don't get any smaller!

I'm reading this now and realizing it's likely some lame old joke, but it's the first time I heard it, and it made me laugh.  Gotta love when people can laugh at themselves too.

A New Record!

Eight out of eight intakes showed up this week!  True, we had to cancel one due to an interpreter failing to show, but this is still a record for me.

Anyone in social services is bound to know that client's not showing for scheduled appointments is one of the most long-standing problems in our work.  If we don't make our numbers, programs may lose funding or we may not get paid.  It also means delays in clients getting the help they may need.

What a great way to go into the weekend!

Olfactory Advice

One of the best pieces of advice I ever received from a professor when I was in college was totally unexpected.  When we were first year and learning about doing intakes, she cautioned us to be prepared for meeting people who smelled bad.

In our line of work we are often meeting people who have poor hygiene (for various reasons) or who are living in spaces that are not clean, and therefore smelling a lot less than  fresh.

It was a quick off-handed comment for the professor to make, but something I totally had not considered up until then.  I think it prepared me to handle some stinky situations with more grace than I may have otherwise, and certainly reminded me not to pass judgement on someone for their olfactory state.

Eight years later, if I had a dollar for every time I've written "malodour" in a note...

Mental Health *headdesk* Moments

How how HOW does a client who tried to kill himself TWICE this week and was brought in to hospital BY THE CRISIS TEAM, who found him intoxicated and holding a knife get discharged from emerg without ever getting admitted?!?!?

Five Minutes to Five

The time of day at which I put my phone to "Do Not Disturb".  Because no phone call at this time of day will last less than 5 minutes.  It's like, a law of nature or something.

Sleep Dialing?

09:26 - Woman leaves me a voice message asking me to call back to reschedule her mother's missed appointment

09:40 - I return the call.  Woman answers and asks if I can call later today, as she's still in bed/just waking up and will be out to another appointment at 11:00.  I'm busy all day with appointments and won't be able to call her back, so instead spend 15 minutes on the phone with her while she tries to book an appointment with me and asks me who I am and why I'm calling about 10 times.

This is what I get for returning phone calls promptly.

Updates

I really do love getting updates about my old clients.  Especially when it is good news - like hearing that they finally got a subsidized apartment we were waiting for/fighting for for the past 2 years! (she was waiting 10 years for housing, I was only around for the last 2)  Or got promoted to a full-time position at work, when last I saw them they were considering quitting the part-time position, as they were sure the employer was unimpressed with them.

Keep the good news coming!

Detached

The relationship between a client and a social worker is one that is highly professional and can be intensely personal at the same time.  Navigating the boundaries of this relationship can be challenging as a result, but that's not really what I want to get into in this post.

In our involvement with clients, we are sometimes witness to or even participants in some of the most intensely personal moments in a client's life.  And while we may be clear on our role (let's hope we're all up to date on our ethical practices) what can be less clear is how to feel about being a part of these moments.

Today I took a client and his cat to the vet.  He was having the cat put down.  It would have been better if he had a friend or family member to give him a ride and offer support, but there was no one else but me.  The client was very accepting of the fact that this was the right thing to do for his pet who has been sick and suffering, but was obviously still heartbroken to have to go through it.

On the trips to and from, we talked about how he was feeling, his plans for getting through the rest of the day, who he could call for support.  We joked about things to lighten the mood, and he told me happy stories about when he first got the kitten.

I was happy that I was able to support him today, and he didn't have to go through this difficult experience alone.  At the same time, I felt really - weird about being a part of this event.

I love animals, but this was not my cat.  I'm not much of the weepy type, so I wasn't personally upset that the cat had to go.  I like and respect my client, but we're not friends.  I'm not personally invested in how he feels about this loss.  I care and I sincerely hope to see him come through this experience okay, but that's it.  What was upsetting to me was that my presence at this occasion meant a lot more to the client than it did to me.  He deserved to have real love and support today, and all he had was my empathy.

These are the limits of our engagement with clients. If I had cared more, if I had become personally affected, that would be a whole other problem.  So this is one of the challenges, especially if providing long term support to clients, that we inevitably face.  How can we encourage and support clients to develop real loving caring relationships which are not so lopsided?  Which don't involve someone who is being paid to care (that sounds cold, but hey)?  And how do we as workers debrief when we feel too little as opposed to too much?

If only *this* was what we dealt with as housing workers

Bright Ideas (Lame Jokes)

Source

Imagine if...

I'm not on tumblr so couldn't reblog directly, but I found this via Geeky Therapist
From the original post:

This is the greatest thing I have ever seen. People do not understand that mental illnesses, such as depression, are actual chemical imbalances in your body. They are not brought on by choice. My dad was diagnosed with depression. He was so ashamed of it that he hid it from me and my brothers. A month later, he killed himself. The stigma that comes with mental illness made my Dad embarrassed to talk to his own kids about this problem because he felt like less of a man.

Erase the stigma. The more we talk about mental illness, the less likely it will end in suicide.

Pass it on.

Call to the Resource Line

Mental health resource line, can I help you?

Hi, I'd like some help to find resources for my daughter, she's 23 and...oh shit!  Here she comes and she looks pissed! *click*

Moving desks

always unearths some interesting things.  I've worked out of the same office for the past 4+ years, but this week am making the move to one of our other locations.  So far I have found copies of assessments we haven't used since 2009, boxes containing two out of date versions of my business cards, brochures for programs that no longer exist, a Palm Pilot case (!), and old papers.  Sooo much paper!  Who even uses paper anymore?

Okay, I use paper some times, but will avoid it when I can.  I had so many folders of handouts, resource guides, meeting minutes and the like, none of which I had looked at in the past 4 years.  I'll Google it before I open my file drawer.  When I go to a training, I usually ask for the presentation to be emailed to me.  If it's an agency wide training,  the information is scanned and made available in a shared network folder.

Is this finally the dawn of the "paperless office" we heard so much about in the 90s?  I, for one am happy to no longer be hoarding bits of dead trees in my workspace.   Everything seems lighter and cleaner!  Even spacious!  I rejoice in this clearing of clutter!  I revel in the ability to find resources at the "click" of a button!

Until the day the power goes out.  Then I'm screwed.  Here's hoping they have back-up power at that new office.  :p

A Motto For Social Work (and everyday)

Source: Therese on Pinterest

Floating around on Facebook today...

Found at: Beatrice the Biologist

The Problem With a Waitlist

Image found at http://oldgoldandblack.com/?p=27171

Is when you call a client who has been on it for months, possibly a year or more and they have NO idea who you are or why you are calling them.  We do check in calls with people while they are waiting, but there is still so much confusion.

Amongst other issues.

Insight

from hosp records:

"The patient stated that she was also worried about all the other patients, that they were given unhealthy food and carbohydrate loaded food."

In the doctors assessment notes and the referral we received for this client, she was presented as being a trouble maker, difficult and bothersome.  She called every hospital administrator she could track down to complain about the hospital food.

Sounds to me like she just knows what's going on!

Eye of the Hurricane

For the first time in over 5 years, I have no clients.  I have officially discharged everyone that was on my old case list for my old job, and am waiting to be assigned the clients for my new job.  It feels kind of...weird?  I have work to keep me busy, but in the meantime there are few appointments to attend, no follow ups to arrange, and no messages on my voicemail (that part I really like).  I'm trying to take advantage of this time to get myself ready for whatever comes next.

Cuppa Care

In my personal life, I have a pretty simple solution for just about every problem in life.  TEA!  When faced with just about any ailment or annoyance, a quick cuppa can help me feel better.  If only I could apply this to social work.

Depressed?  How about a colourful flowering tea to brighten your day?
Feeling anxious? A warm cup of ginger with honey to sooth and take the edge off.
Feeling lonely?  Why not spend some time with your friend Lady Grey?
Can't get to sleep?  Drift off with some chamomile.
Lacking energy and motivation? Some zesty lemon green tea should get you going.
Trouble getting along with the people in your life?  Bond over a boiling pot of chai.
Feeling broke and cold?  Hold that mug in both hands and feel it's warmth.

I mean, the list could go on all day.  If only our work were so simple and delicious.  I'm going to go brew some now!

Up In Smoke

It's got to be one of my least favourite thing about my job - my hair and clothes smelling like smoke after doing home visits*.  Many clients are courteous, and don't smoke while I visit.  Some just find it too difficult to  it though the appointment without smoking.  In summer we often accommodate this by meeting outside.  But it's currently winter here in Canada, and temperatures are too cold for that.

Some job postings in this field state that the candidate should be aware they will be in smoking-environments.  Mine didn't but I've long recognized it as an unavoidable workplace hazard.  Sure, if I really wanted I could try to insist that clients meet me elsewhere, but the home visit plays an important role in my work, puts focus on me rather than the client, and possibly makes them feel guilty.  That's not what I'm trying to do folks.  Besides, it's their room/apartment/house.

Not so fun fact: rates of smoking for people with schizophrenia are estimated at about 88% - three times that of the general population.  And smoking cessation is just not high on the list of goals or priorities for most of my clients, who are busy trying to manage their symptoms, maintain their housing and survive on a few hundred bucks a month.

So until this changes, you'll see my huddled in my big coat and hat, driving with my windows down in winter trying to air myself out.

*not every home visit.  About half my current clients are smokers

Maybe her social worker

suggested she write a letter to "show her feelings"  

Original photo at Jeff Simmermon's photostream

I first saw this on And I Am Not Lying

New Year, New Job

...except it's my old job.  Yep, I'm going back to intake!

I'm looking  forward to seeing new faces on a regular basis.  Also, my case load will be shifting to short term supports instead of long term, so I will be leaving all of my current clients.  I'm not looking forward to that part so much.  Telling client's you are leaving them is never easy, and some of these folks I have worked with for 4+ years.

Wish me luck.