Focus on the good

As a case worker, wherever the road takes us, we go. People come in with all kinds of needs. Some need a job and/or housing, in addition to getting help for their substance issues or mental illness. Others just need to maintain where they’re at in life. For some clients, picking up their medication every week and taking it every day is as high functioning as they will ever be.

When work gets overwhelming, I take my mind off it by exercising or watching TV at night.

I don’t see many big successes, but I do see a lot of small triumphs. The world is filled with a lot of bad things, but you have to focus on the good ones.



Why social work?

Growing up, I was a big fan of the TV show “Judging Amy.” The mother in that show was a case worker. That’s when I first learned what a case worker did. I was interested in it, though in college I majored in psychology, religious studies and theology, with a focus in grief counseling.

In my first job out of college, I was a case manager for people with HIV/AIDS. The people I worked with had a spectrum of problems, including mental illness, drug abuse and homelessness. As a result, the transition to Recovery Resources wasn’t too difficult.

My favorite part of the job is interacting with the clients and hearing their stories. A lot of people don’t have the opportunities I did. Society forgets that they’re people, too. I truly believe that if society was different, we wouldn’t need case managers.

How my time is spent

Every month, 55 percent of my time must be spent in direct service to clients in order to reach the “productivity” goal. It ends up being about 88 hours. I’ve met it every month so far!

The other part of our time is ideally allocated as follows:
Documentation, 25%
Travel, 15%
Administration, 2%
Consultation/Supervision, 2%
Training, 1%

A little bit of this, a little bit of that

I had to tell my clients who are switching levels of care who their new case manager will be. Some of them were upset since we had gotten to know each other.

Other than that, the day was normal. I had a lot of no-shows. I did a home visit with a client who uses the para-transit system and took him to the food bank. I also did a home visit with a client whose mother just died. I wanted to see how she’s doing.

One of my clients has to go before a judge. He is a sex offender who didn’t properly register. If he is found guilty of hiding his address, he could serve between two and eight years.

...yup, just another day at work.

Changing levels of care

I went apartment hunting with Paul a while ago. It went well and we found him a nice 1-bedroom efficiency across from a hospital. He liked it but wanted to see other places. He’ll have to apply, but he wouldn’t sign his name for anything because he’s paranoid. In the car, after looking at a couple of places, he talked it over with himself. It’s interesting and frustrating.

Because he utilizes so much time, Paul will be moved up to a higher level of care. Recovery Resources divides levels of care in four ways. My clients are supposed to be level 1 or 2, meaning they are a bit higher functioning, and I only need to see them once or twice a month. Clients like Paul and Joshua are really closer to level 3 or 4, with more significant needs. The agency is re-arranging case loads to more accurately reflect clients’ needs. Including those two, 28 of my clients are moving to a different level of care. They’re mostly the ones I’ve gotten to know very well, since they’re the ones I see all the time. But now, I’ll be able to see more of my clients.

Helping the way I know best

The only identification that one of my clients has is a court-ordered community service document. The doctor says he’s fit to work, so he can’t get Social Security. But he can’t get a job without a birth certificate, and he has no money to get a birth certificate. It’s a vicious cycle. I wish I could just give him $25 for the birth certificate, but I can’t, because then I’d have to give all my clients $25.

All I can do is help him the way I know best. I helped him apply for food stamps and he got them! I celebrate the small victories...that’s what keeps me going.

Documentation

A large part of my job is documenting my encounters with clients. There is a set format we have to follow for our notes:

1. Summary of Individual Service Plan (ISP)/Individual Service Treatment (IST)

Discuss goals, objectives ordered and objectives addressed

i.e. If a goal is “search for housing,” I might say that at our meeting today, I helped the client figure out what percentage of his income would be spent on rent each month and linked him to an organization that helps find housing.

2. Provide therapeutic intervention

i.e. Ask client, “How’s the housing search going?”

3. Client response

Quote them, if possible. Include any clinically significant events. Are they compliant with their medications?

4. Justify the need for follow up

Include progress/lack of

5. Plan follow-up

What we’re going to do next session. Include recommendations for modifying the treatment plan.

6. Date of last/next psychiatrist visit

Recovery Resources’ CPSTs write notes concurrently with the appointment. I have my laptop out and will type sometimes while the client is talking but I try not to do it too much to detract from his or her attention. If I don’t have a chance to write notes concurrently, I do it right after the session.

Notes can take up to 15 minutes depending on the content of the session. Sessions are typically between 30 and 60 minutes long. Phone calls are billable (and thus note-worthy) after seven minutes. If someone talks longer than three minutes, they’ll usually talk for seven.