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...

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...

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?

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.

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.

The Twelve Days of Christmas - Social Work Edition

Like absolutely everyone else, those of us in social work often find the days leading up to Christmas to be particularly hectic.  It can be a hard time of year for many of our clients, so they may need additional support.  There are many charitable goings-on that we may be involved in, and most of us hope to get a couple days off with our own families.

Here's a little ditty to give you an idea of what the holiday rush looks like for us.  Feel free to sing along!  (I'm not typing out the verses over and over, you all know how it goes!)

Twelve grocery gift cards

Eleven overdue assessments  

Ten client Christmas parties  

Nine home visits 

Eight food hamper deliveries  

Seven flu shot clinics    

Six church hall turkey dinners  

Five volunteers!!!!!    (we love our volunteers)

Four donated toy drives     

Three office potlucks  

Two emergency room visits    

And one last minute crisis call!

  

Hierarchy of Care

Yesterday I took a client to a doctors appointment.  We arrived about 5 minutes before the appointment time, but as with most doctors this one was running late.  No biggie.  After being there about 25 minutes, we and one other gentleman are the last in the waiting room.  The doc calls the other guy in and tells us "there will be no more waiting, I am missing my lunch hour".  I told him I couldn't continue to wait over his lunch time, so he let the other guy hanging out to dry and took us instead.

I told him I appreciated him seeing my client first, and he told me that next time we should not expect our appointment to be on time.  I told him I was okay with waiting 20 minutes or so and try to account for this in my scheduling, but I have other appointments to get to as well.  So he said that when I am bringing a client to see him I should not book any appointments for the rest of the day.  Because he might have to fit in patients who are suicidal, or in crisis.  WHAT DOES HE THINK I DO ALL DAY????!?!?!!?

I get that doctors are busy.  Their job is important, and I have certainly been appreciative when they will rearrange their schedule to see one of my clients who is in crisis or suicidal or whatever.  But why is his schedule so much more important than mine so that he can tell me how to arrange my day, and how to do my job?  I have other people to see too!  And don't expect me to feel sorry that your lunch will be delayed when I had to eat a sandwich in my car while making the 40 kilometer trip to pick up this woman whom he will now see for 5 minutes.   I may have been more sympathetic if he hadn't been so rude about it.  An over-inflated sense of entitlement won't get you far with me.

What Makes Me Happy

This is about a client I had when I first started this job. I may have reflected on this story before in my blog, so bear with me if it sounds familiar.

He had been in the system for years, and had previously been supported by a coworker who left for another job.  He was a young man with schizophrenia and developmental delays.  He lived with his family (who wanted the best for him) including his grandmother who brushed his teeth for him even though he could do it himself.  It is fair to say there was a lot of learned helplessness going on.  

I was a little more eager and a lot less experienced then.  This man was more ill than anyone I had worked with previously.  My normal tactics did not work.  We were down to real basics - getting him to remember who I was, and remember his appointments.  Our appointments consisted of me trying desperately to make some kind of conversation while he was more interested in watching soccer or getting me to take him out for pizza.  All the while granny is knitting in the background and making me hyper aware of my youth and inexperience.  

I don't remember what the incident was, but somehow he ended up in hospital.  The family and I worked with the doctors to get a med review and he was started on Clozapine.  While he was still admitted I advocated to get him in with our ACTT program (Assertive  Community Treatment team - a more intensive level of support than what I provide) and he was accepted, so I never really saw him after his discharge from hospital.

Until one day I was in the waiting area of a psychiatrists office with another client.  I recognized this man's sister and then he came out from his appointment.  He looked me straight in the eye and said "Hi Nectarine" and then proceeded on his way.  

That was it.  But it was so much!  This person, who had met me at the door with a blank face week after week, giggled when he couldn't remember my name for months over a year prior at this time had said HI and addressed me by name!  He now attends one of our drop in programs and I see him over there from time to time.  Every time this same thing happens.  He says hello to me the same way, and then walks away.  It's all I'm likely to get, but it's so much.  It makes my day every time.  

Will this client continue to recover?  Probably.  Will he recover to a level that other people find "normal"?  Probably not, but to me, all the work he and his supports have done is so worth it to bring this human being out of the bubble his illness and medications had put him in.  I'm grateful to have been a small part of it.

The Big Barn in the Sky

For some reason I remembered this story the other day and thought I should share.

This was a couple years ago when I was in an intake worker role.  A young woman had been referred to us who at the time was staying in temporary crisis housing for people with dual diagnosis (in Canada that refers to mental health and developmental disability).  Usually we would do intakes at our office but since she had no transportation, was not familiar with the area where she was housed and was in a pretty dire situation we agreed to meet her at the place she was staying.  Since this was an off-site visit with a client we'd never met before, and since we were curious about the program supporting her (hadn't dealt with them before) my intake partner and I decided we would both go to meet her.

This young woman had been through a lot.  Most notably, her mother had died recently and that among  other things ended her up in the crisis housing.  She had no other family, but did have close friends who were now her guardians and she would be moving in with them soon.  Despite everything she'd been through and her DD, she was engaging, optimistic and had a sense of humour throughout the interview.  We got all the information we needed, told her about our program and let her know we would be in touch.

Once outside, I commented to my partner that I was impressed  and pleasantly surprised at how together and well this young woman had seemed.  She looked at me with utter confusion and said "What?!  She was either psychotic or her cognition is lower than we thought.  All that talk about how her mother "bought the farm"?  I don't think she understands that her mother DIED, I'm really worried about her!  She thinks her mother is on a farm somewhere!"

At which point I burst out laughing and had to explain the euphemism.  It was a cute moment.

But not much

Me: (asking about psychotic symptoms when filling out a client-directed assessment form)

Client: Sometimes I know things nobody else knows.  Just put down "a little bit psychic".  

Progress...Noteszzz...

What is a tactful way to record that a client repeatedly fell asleep during an appointment?  Poor person fell asleep while I had her at the psychiatrist, slept while I drove her home and fell asleep on her feet while I was speaking to her mother afterward!

Taking the Long View

I remember when I interviewed for my current job and was asked how I would handle transitioning to providing “long-term supports” - I was already working for this agency doing short term and crisis response work.  The director who was interviewing me stressed how challenging it can be for both worker and client to maintain hope, focus and direction over a long time.  I hadn’t really thought about it before, but must have come up with a reasonable answer, since here I am as a long term case manager.

I’ve now been in this role three, almost four years.  Some of my clients have been with me as long.  One of my very first clients has had problems with her housing situation since before I began working with her.  She also had mental health and physical health problems, family and financial issues amongst other challenges.  Basically, we both realized that until she had more suitable housing, it would be difficult to focus on her recovery, and I could basically only help her to “get by” in all the other areas mentioned.  Right from the get go I got heavily involved in working to address the housing problem.  There were family members, multiple agencies and her own issues to consider in this work.  What she needed was a first floor apartment (safety and accessibility issues) with three bedrooms (two kids of disparate ages and genders) in a particular area of town (so one child could attend a special needs school) with no carpet (severe allergy problems) and that would be eligible for the rent subsidy she receives (landlord would have to agree to work with that program, program would have to approve it and have the funds for it).  Like finding decent housing isn’t hard enough!

 

I won’t go into detail about all the ups and downs in this process over the past few years.  I will just say that a couple weeks ago, I got a call from a staff member at the housing agency.  I could hear excitement in her voice as she told me that she was looking at an apartment that she thought would fit all my client’s needs and criteria.  She could arrange a viewing in a couple days. 

The client came, kids in tow and looked around.  She couldn’t have been in the place more than 3 minutes.  It wasn’t going to work she said.  Why, I asked, as it had everything she wanted.  Did she want to take the kids to the park so we could sit and talk about it?  No, she wanted to catch the next bus, everyone was hot and she wanted to get home.

That was Friday, and on the Monday I met with her.  It went back and forth, she could see the advantage of the place, but there were certain problems…could she view it again?  I made the call and set this up.  My hopes were high, because I hadn’t even expected this much.  This time she came alone, left the kids at home.  Took a little more time looking around.  In my head I’m making plans about how to apply for grants to help cover the moving expenses, when I’m going to fit in an appointment to take her to get the key…the housing worker tells her she will need to know by the end of the day if she will take it.  I will call her in a couple hours to see what she has decided. 

When I do, she’s not ready.  Can I call later?  Of course I can.  This happens a couple times, until finally I tell her I can’t wait any longer and give her the housing worker’s number and tell her she will have to call directly.  I try to put it out of my mind as I go home that night.

Come the next morning, there are no messages for me.  It’s not until halfway through the day that the housing worker calls me to say that she will need a signed letter of refusal from the client, because she didn’t take the place.  The reason she ultimately gave was that the bedroom furniture wouldn’t fit.

I spent plenty of time that afternoon debriefing about this situation with my supervisor.  It’s times like these that it is difficult to remind myself of all those social work-y truisms – about client directed service, and individual right to determination and all that.  I will still be there to support this client either way, but I have to say I was mad.  As much as I can rationalize about her reasons, and empathize because of her history, I was mad.  Four years of work, for what?  I gave this woman my best and felt like it was totally disregarded that day. 

I know it’s not about me.  But this was one of those situations where BECAUSE I care, I couldn’t just forget about it.  It’s hard to think about possibly several more years of working with this client after this has happened.  This is where the long-term gets really tough.  This is where I start to feel tired and stuck.

The fact is, that what I need in order to keep going here are the same messages we use when talking about recovery.  Patience...hope...a willingness to fail in order to learn.  Finding the small successes that mark our progress.  Letting go of the things we cannot change.  Moving forward, because you can’t go back.  This is what will get me through the next four years of trying and trying again.  I can only hope that I will be able to inspire the same in my client.  After all, she is the one who must continue to live in her current situation.  And ultimately, she will be the one who determines when and how it changes.  Maybe I will even be there to cheer her on.

Newsflash: Stubborn Man Defies Death

What do you get when you forget your insulin daily, and subsist on a diet of cookies and Ensure?  A blood glucose level of 55!  Along with a panicked call from your doctor telling you to go to the hospital RIGHT. NOW.

But do you go to the hospital?  No, of course not.  Because nobody is going to tell YOU what to do.

*headdesk*

That's what She said

Me: So how does your ex-wife feel about this change?

Client: Oh, she's okay.  She's come to terminologies with it.