Case Mgt-316

Brian Hensley BP-007

Interview: Case Worker

I spoke with Rick Wisecarver a former case worker at the ARC of Washington County. Rick has had nearly 15 years experience in case management and now is the executive Director of Residential Services for Prolex Inc. Prolex is an organization that provides supports and necessary assistance to individuals with developmental disabilities. Prolex also has individuals with dual diagnosis of MR/DD and mental illness

I asked Rick the following Questions.

1.        What did you find to be the most rewarding part of your work as a case manager?

The most rewarding part of the job was the ability to help others and make a difference in their lives.  To see that my work was actually making a difference in their lives and ensured they were receiving the appropriate supports and services as recommended by clinicians. 

2.        Was it more or less complicated working with individuals with dual diagnosis such as MR/MI

Working with individuals with dual diagnosis is always a challenge as they are already dealing with the issues of mental illness then to add the disagnosis of mental retardation makes the treatment that more challenging but can also be rewarding when you can make a difference. 

3.        What was the most upsetting part of your work as a case manager?

The lack of supports and services and the lack of funds avaliable to assist those with special needs and services that were almost impossible to locate within the Department of Intellectual and Disability services. 

4.       Can you remember and explain the most rewarding time being a case manager?

The most rewarding was when I was able to help an individual get 24 hour care that was living in a home with no access to a bathroom or shower and no transportation to get out of the home due to mobility issues. 

5.        What was the most difficult time like being a case manager and why?

I found the job very rewarding and challending but the difficulty was the system not the clients

Week 6 Blog

Local and Regional Guide to Social Welfare Resources

Greeneville Food Bank

107 N Cutler St, Greeneville · (423) 638-1667

 

Gods Store House

601 W Broadway, Newport · (423) 623-4855

Berea Free Will Baptist

2415 Sinking Creek Rd, Johnson City · (423) 928-5376

Greeneville Seventh Day Adventist Church

Asheville Hwy Greeneville TN

Montvue Church of God

42 Montvue Ave, Morristown (423) 581-2337

Asbury United Methodist Church

157 Main street, Greeneville (423) 638-8890

Medical/Dental

BMS Rural Clinic- Free health screenings and treatment

Bristol, Tn (Seasonal)

Laughlin Memorial Hospital- Free health screenings

Greeneville,TN (Varried offerings) see receptionist

Fort Henry Mall-Heart Couch- Free health screenings

Kingsport, TN (Varried offerings)

Dr. Edenfeild (caregivers only)-Discounted Rate

East TN

Dr. Gambel Discounted Rate/Sliding Scale

BMS Rural Clinic (Seasonal)

Counseling

Brown Springs Baptist Church

Moshiem, TN

First Baptist Church

Morristown, Greeneville, Johnson City, Kingsport

Church Street Pavilion

Greeneville, TN

Free counseling to students of local colleges: Walter State Community College, ETSU, UT, Tusculum College, King College. See “Student Affairs” department

Home Energy Assistance

Upper E-TN Human Development Agency, Inc

301 Lois St., Kingsport TN (243) 246-6180

Other Social Welfare Services

Disability Services

134 W Summer St Apt 1, Greeneville,TN

Rural Recourses (Housing, Social Services)

2870 Holly Creek Rd, Greeneville , TN

Step (Children with disabilities in the school system)

712 Professional Plaza Drive, Greeneville, TN

Small Miracles (Child Care)

2001 West Main St. Greenville, TN

Comprehensive Community SVC (Alcohol Treatment)

128 S. Main St #301 Greeneville, TN

UETHDA Head Start

310 Floral St Greenville, TN

Summer House (Residential Housing)

1040 W Summer S Greeneville, TN

Volunteer Center

615 W Main St, Greeneville TN

Probation and Parole Board

716 Professional Plaza Drive Greeneville TN

Rehab Care Group (Therapy and Senior Counseling)

124 John M. Reed Rd, Limestone TN

Christian Counseling SVC&Wdd

45 Rader Sidetrack Rd Greeneville TN

Crumley House (Brain Injury – Residential and Day Services)

300 Urbana Rd Limestone TN

Appalachian Family SVC

527 Warrensburg Rd Greeneville TN

Stepping Stone Youth Treatment

110 Stepping Stone Blvd Limestone TN

Appalachian Girl Scout Counseling

3175 Middle Creek Rd, Greeneville TN

Thomas R Herington, Licensed Professional Counseling

110 Stepping Stone Blvd Limestone TN

Foster Grand Parent Program

4850 East Andrew Johnson Hwy, Greeneville TN

WUMC/Asbury United Methodist Church-Prom Closet/Seasonal-discounted

512 Main St Greeneville TN *See Barbara Lawson

Additional Services …..

***Financial Assistance***

Department of Human Services-Conditional

American Red Cross-Conditional

Health Department-Conditional

Habitat for Humanity-Conditional

Blog 5

Chapter 11 :

Chapter out line: Handiling Anger

How to address and Disarm Anger

3 reasons for Anger

+Anger concerning agency procedures

+Anger concerning something you have said or done

+Fear/Client

+Exhaustion/Client

+Overwhelmed/Client

+Confusion/Client

+the need for attention/Client

Many factor and reasons can attribute to your clients emotional stability. Situations may not always be in our control to prevent however we can manage the consequence. We will with time and practice to effectiveliy de-escalate a potentially volatile situation should it arise.

Is Disarming Important?

When the client’s anger cannot be prevented or anticipated we must attempt to disarm and de-escalate as well as possible the following will list a few options to always remember.

            Always Remember the following…

+Eliminating obstacles for a better understanding

+Show respect to the client

+The worker will gain a better understanding

+Opportunity to practice empathy (Always practice in every situation)

+Redirection to a solution.

Remember the phrase” the bark is worse than the bite” Often anger comes across or is portrayed to be worse than it really is. The client may be less upset than they really sounded and can be de-escalated to an extent.

#1 Mistake to AVIOD

Don’t take it personally!... This is easier said than done especially when dealing with anger. It is too often common for social workers to take the anger personally and respond in such manner. In defense of the worker some clients can be difficult to deal with. When anger is responded to with more anger the working relationship can have a detrimental falling out with bitter feelings being held by both worker and client.

Reality Check-Expectations for Communication

Workers often believe that their client will never be upset always be appreciative and every person will be happy. This is a trap. As with normal daily life in the world every person is different and that is exactly how it will be during our appointments with our clients. We must remember to not take any emotional outbursts as a personal attack but rather be concerned as to what the problem may be to cause such an emotive reaction.

Disarming in 4 easy steps

+Be appreciative

+Inquire for more info

+Find some common ground to agree on

+Focus on the solution

(This is easier read and studied than completed on an angry situation but since this cannot be practiced it must be done as the situation presents it unfortunately the practice time is during a volatile emotional situation.)

Common trip-falls

            Always avoid…

            Try not to become defensive (easier said than done)

            Don’t be facetious-Don’t be sarcastic

            Don’t patronize- don’t act superior

            Don’t grill the client

Information

Always take every opportunity to gain information. The more info we gather the better we are armed to handle a situation, understand and effectively manage a problem. We can read between the lines of what is being said and or not said to get to the route of the problem and effectually and collaboratively formulate a solution.

Managing the Anger

The clients outburst cannot always be predicted other than the simple fact that it can escalate further. A client can often become more and more upset and go from anger, threats and physical harm. It is common knowledge that these types of situations occur often in professions dealing with the public.

Often we are essential in this process. We are the front line so to speak to de-escalating angry outburst. Often the client is not upset with you personally but may be yelling at you. Your reaction, tone and movements can greatly help in reducing the anger level. By speaking in a softer tone or slightly lower level, moving slowly (having an open and non confrontational posture) and listening while remaining calm can give us valuable tools in regaining emotional composure.   

Article in Review…

It is common knowledge that social workers may or can sometimes be difficult and overwhelmed. Many movies, shows and portrayals show the worker as an over worked, underpaid and abused person that may “snap” at any time. It often shows the worker as being ill and hateful. This is accurate to an extent. The worker is over worked and overwhelmed, underpaid and at times abused and if self care is not taken in some way to vent the frustration then this can be the case. In the clip it showed a young mother with several children requesting assistance. The mother stated that the children had three separate fathers and none of which were paying any child support. The mother refused to pursue that issue. She had a boyfriend who was unemployed but staying with them. She was unable to buy groceries and proper nutrition for her girls. She was seemingly frustrated with the situation, tired and had her hands full taking the children with her everywhere.

Upon entering the DHS building and after completing the proper forms the worker received notification of the request and prepared to start a new intake. The worker was just coming off a coffee break with other workers. The worker and her colleges were discussing the much distorted fact that the situation she was about to deal with as being a rising trend and is largely do to lack of values. When the worker met the mother as the children began to touch various things on her desk and shuffling important papers. The mother was fussing at the children to stop and the worker seemed to remain calm other than some facial expressions of getting upset.

After filling out the initial first pages of the assessment the worker began to ask more questions and discovered the young unwed mother of three; all with three separate fathers and living with a boyfriend. Now at that point the worker seems to “snap”, she became very upset and scolded the children for touching her paperwork. She then began to question the mother in a harsh manner using sever wrong ‘I’ messages. The worker sounded as if she was the moral compass and the young lady was in the wrong for allowing herself to get in such a predicament. As the anxiety level rose for the worker so did it for the client. By the end of the clip both the worker and the young mother were upset and quite loud.

Not only did the working relationship suffer but the loud nature of the situation cast a black cloud on the potential clients in the waiting room. It showed one older female as thinking out loud that “if they treat her like that then I am gonna get treated like that”. It showed the older female leaving the DHS building without receiving much needed nutrition assistance because she felt as if she was asking for a “hand out” she assumed this after over hearing part of the situation with the worker and previous client.

Video Link

Question…

I completely understand the concept but my question is when do you seek assistance? Since this can only be practiced during a situation how do we handle it when we are in the middle of the situation? In the video it showed a worker that obviously needed a break. She should have stepped away from the situation to put her feelings aside and work with the client in an objective manner to resolve the issue. Is it common for a worker to lose their cool in the middle of an assessment and is it neglectful on the workers part for starting an assessment in an emotionally compromised state?

Blog 4

Chapter 10:

Chapter out line: Bringing up Difficult Issues

We may find it necessary or hear or be concerned with during the course of our work that wants to make us ask more questions. At times the maladaptive behavior and or situation may call for us to explore more with the client. When this is completed it is a confrontation. To confront the client the following list several do and don’ts.

Confrontation-When to use

Discrepancies

Say one thing but do another

A difference of perception between client/worker

Contradictory value beliefs and behaviors

            Extra’s…

            Unrealistic expectations Worker or Client

            Seeking help/Contradictory behavior

            Client’s contradictory behavior

I-Message-Confrontation

The I-message usually contains 4 parts consisting of

+Personal concern, feelings and observations about the issue or situation

+A description of what has been seen and heard-non-blaming

+Tangible outcome for the worker and or consequences for the client

+Collaboration on a solution/invited

Confrontation Rules

As with all confrontations sometimes it cannot be avoided however it can be controlled to an extent simply by controlling our reaction. The following are some simple things to remember but will take time and practice to master.

Be mater as fact!

Listen!

Put your focus on tangible behavior and communication.

Make sure you take complete responsibility for your actions and observations

Don’t accuse

Don’t do it because you’re angry

Don’t judge!

Don’t give the answers

Always..Always be collaborative

Other options…

Sharing Ideas-Sometimes we may want out of interest in the client’s wellbeing that we will want to offer solutions or ideas that may bring some needed relief of options for a potential solution. As with all things ask for permission before doing so as some clients may not want your ideas.

Advocate-We may find it necessary to “Stand-up” for our clients at times. They are seeing us for a reason and may be somewhat venerable in some manner such as Confidentiality to disclose in a private manner. Ie. If a caseworker always leaves office door open during appointments and the office being located at the front entrance with conversations easily overheard.

Don’t be pushy!

At times we may be put in situations where because of our personal experiences and beliefs contradict the action of the client. We also can get tripped up and send the wrong messages. We must remember what our I-messages say. As a worker we can still hold our belief and conclusions but put it in a way that the client does not take our actions and assistance as being overbearing and pushy.

It’s all in how you say it…

Article/Video in Review

I thought that the situation came across as awkward and forced. I suppose that was the intention for the worker as the client delved deeper into the abuse and brought fourth new emotions. On the clients part she seemed to have to force herself to deal with the sexual abuse from her father. At first I felt slightly uncomfortable because the young lady seemed so uncomfortable in the presence of such an intimidating male worker. Although the workers actions were benevolent the fact that he was confronting her inability to dig a little deeper into the issues struck me as being off. I found his mere presence a factor. He was a tall, muscular built man ironically to that of her father; the abuser. I found the video less of an example on confrontation but more of a lack of sensitivity to the client’s situation and possibly pushing her to hard considering her venerable state.

Question???

When confronting is it as simple as the book and video portrays it to be or is it mastered over time and experience? Seems to me after watching this clip I am now more confused as when to push and confront or not to push. Is this something that is only mastered through experience and time or can it be achieved through mentally preparing yourself.

Link…

CASE MGT Week 5 Last post

Blog 3

Chapter 9: Asking Questions

Chapter out line: Using open and closed questions

Why do we use Open/Closed questions

As a case worker we are often seen as having the answers. We can often feel nervous regarding this as we are naturally filled with questions. As we attempt to understand the situation and the client we may ask an introductory question but this leads us to more questions. The strategy would be to ask the most pertinent information gathering questions as possible but allowing the client to “tell their story”.

A. When to do which?

A1. When opening/starting the initial case/working relationship

A2. For assessment and external or specialized referrals.

A3. When attempting to encourage your client to delve deeper into the emotion or for clarity and personal understanding.

 B. Closed Question

B1.Defines as a question that requires a single answer. (This is as simple as it sounds.)

Examples would include...

Are you male/female?

Where do you live?

Why are you here?

How did you do that?

C. Open Question

C1. These types of questions serve to worker as ways to gain more understanding to the problem issue and the client’s point of view and if we have an internal question that comes to mind we can use the questions to explore more. These also put the client at ease as they can be guided to articulate of formulate out loud the problem. In my experience the simple step of saying that you have a situation or issue is liberating in itself.

Examples would include…

Can you tell me how that made you feel?

Will you tell me about your childhood?

How did that make you feel then?

Don’t make it uncomfortable

The process is sometimes difficult enough and often an uncomfortable experience for the client. One of our many goals is to help put the client at ease and make the working relationship and mutually beneficially one. We have many areas to avoid to help us ease this process for the client and is listed as follows.

Types of questions to avoid…

*Avoid the “why” questions ie. Why did? Why didn’t?

(This implies that you feel that the was a right and wrong answer or handled differently)  

                *Avoid multiple questions ie. Asking one question followed by another then a yes or no question

(This type of questioning can often make the client feel interrogated and like your searching for a specific answer rather than just\listening to the whole story.)

                *Avoid Changing the subject ie. Talking on one subject matter and abruptly change to another.

                (Just for the simple fact that this is normally a social taboo it can disrupt the entire session)

                *Avoid only one right answer ie why didn’t you tell someone?

                (This implies to the client that there is only one right answer)

                *Avoid putting on your morals/values ie did you tell him the truth?

(This implies to the client that their values are different and possibly sub standard to your implied superior morals and values.  )

*Avoid assumptions ie. You did say you’re sorry; right?

(Doing this implies to the client that you already know the answers and could come off as arrogant.)

A formula for asking open ended questions

Although this seems to be an obvious thing to do a simple guide was created to ask these questions. At first a beginning worker may feel overwhelmed and might be unsure of one’s self and abilities. This might lead the worker to be nervous and feel lost during the questioning.

(the formula is simple) with a few simple leaders such as Can you?, could you? With these the worker can branch off to other leaders such as spell out..Talk.. After getting started with these you can use softeners and ad one such as a little bit more?..or something more about?  After this is complete you can assign a subject with the discussion such as your husband, child, what was the move like?

All of these phrase’s and starters and be used in endless variations and orders. The basic concept is keeping the exchange of information moving. The more you understand the client the more you will understand their problem and the effect it is having on their life. The key is to keep the conversation going but making sure that it isn’t a rambling conversation but a way for the working to read between the lines and gather information while formulating and articulating a follow up question.

Article in review…

This week I was able to find an article to my satisfaction. As the topic is covering questions and how to ask them correctly I found this article between a difficult client and an arrogant therapist. I understand fully the need for asking a variation of closed and open ended questions and the proper time to use each. I have often seen and read this week what I seen to be callus or uncaring questioning.

The therapist started the interview introducing themselves with many credentials and certifications. The client reported feeling intimidated during the intake. The therapist asked many closed question and to my opinion not very many open ended questions. It is my belief this was completed in this manner because this was court ordered. Although the client may have been made to take the opportunity to deal with some emotional and maladaptive behaviors and could be apprehensive or resentful in the beginning the session could have gone differently had the workers attitude been more open. To me the worker seemed to be acting as it was court ordered. She asked several rapid fire closed questions. She would move from subject to subject as if she was reviewing a check list.

I am unsure if this was an example to workers of what not to do or just an account. However in my opinion this was a prime example of how not to be an asset to others. Not to be possibly detrimental to a clients situation. I personally believe that is malpractice on behalf of the worker.

QUESTION…

Does a social/therapeutic/worker have any legal obligation to “do no harm” like a medical doctor oath? I realize we are governed by principles, rights and ethics however the compliance with those is ultimately voluntary. I guess to clarify my question is what is to stop a rouge worker from being out there taking their own emotional issues on others instead of being a benevolent helping worker.

Week 4 Chapter 9 outline