Mini Reflection

So with everything going on in my personal life I have found it very hard to reply to others on the blackboard this week. Plus when it is just workbook week I get very lost quickly because I think everyones responses are clearly covering the answers in ways I wouldn't have thought of. My only hope is next week I will be able to post more as I hope to get a good grade in this class as it will be the first class I have taken in two years.

Client intake summary of James Peacham

NAME: James Peacham
DATE OF BIRTH:06/15/50
GENDER: Male
DATE OF EXAMINATION: 3/27/11
EXAMINER: Alysha Wood

Reason of Referral: James Peacham entered the emergency room complaining that he felt he couldn't continue to live his life the way it was going. He stated that he is dealing with depression, anxiety, mood swings; manic or depressed, and difficulty paying attention.

Background Information:
James Peacham is a 50 year old Caucasian male that currently reside in your town Vermont. Where is he is currently unemployed, previously he was employed at IBM but with the downfall of the economy he lost his job. He has had difficulty finding a job in his related field. James has a bachelor’s degree in engineering from Norwich University. As a result of losing his job Jame's house has gone into foreclosure and his wife of 20 years has left him. 
During the intake interview James stated that he was generally healthy. But he mentioned that he has been having difficulty paying attention or focusing on the task at hand. This is is driving him nuts as in the past this has never been a problem for him and he was always able pay attention to the finest details. James mentioned that as of late his life has not had much meaning and he has had serious thoughts of suicide. When asked how long these thoughts have been occurring James stated since the day his wife left but more so during the last couple days. Over the last couple days he has really been thinking that would be the best outcome for his life.

Summary at this time James was admitted into IP for further testing due to his suicidally thoughts. James will be  held for 72 hours for evaluation to ensure he is not a harm for himself or others. When the tests come back I will be better able to asses James in hopes of a healthy outcome.

Providing a Safe Environment

This week we talked about providing a safe environment and I take this to mean a couple of different things. If you work with children you may want to have a toy box filled with various toys so the child who is coming in may feel safe talking about different things through play. Or crayons so the child can draw pictures. But if you work with adults you may also want the toy box as some consumers may bring their children in and the toys can be used as tools to keep the child entertained. I know that when I take my son into any appointment with me a box of toys keeps him out of my hair (well almost keeps him out of my hair) and I am able to pay attention to the person I am talking to.
I think if your able to you should put pictures on the wall to make it look less like an office and more like your own place. As it makes it easy to talk someone if the place is not so state hospital like unless that is what the boss is looking for. 
I am a firm believer in white nose as it make me personally work easier and I think for a consumer to come in and know that no one on the other side of the door will hear what is being spoken of will help. I understand that not all offices are closed off in there own room and that they can be cubicals  but figuring out some way to make it private I feel is very important. 
But you can make the space look as warm and welcoming as possible but if your body langue is saying something different then I am here to listen the consumer isn't going to want to open up. From what I have read that seems to be one of the most important things is not to block the conversation but to enhance it. Which only makes sense. 

Midterm over

It's scary to think that we are already half way through this class. It seems like the time has flied right a long. I mean the snow is starting to melt spring may actually be coming unless we get another storm like we did on Monday that practicably shut everything down. Now moving on in the class there is a lot more we are going to learn and I can't wait to see what else lays a head.
But what a relief to have the midterm finished and posted. As I am sure like everyone else Sundays I am busily trying to ensure I have completed all the required homework while chasing a three year old boy around the house.
It only took me have of the class to figure out that I can read others posts on my smart phone I just haven't figured out how to reply. I am sure I can't but it would be nice to be able too.
I hope that everyone in this class is learning as much as I am.

My interview with Michele Corrow

The person I chose to interview for this paper was my boss Michele Corrow at PRIDE Support and Services.  Michele requested that rather then asking specific question an open forum would be better. She is one of the founders of the agencies and has been employed in human services over the last 20 years in various states.  Michele received her master’s degree from Springfield College in Community Psychology.

Our meeting took place at the office which is located in Barre on 36 Summer St.  PRIDE provides services to individuals that have survived a traumatic brain injuries or TBI.  PRIDE is usually the last step in an individual’s road to recovery.  The services included Case management, Community based residential living in the shared home of a trained person, and Community based day supports centered within a person's local community.  PRIDE receives its funding through the TBI wavier of Vermont.  Each individual in services has their own waiver and is given a chose on the agency they would like to receive their services from.  PRIDE is a chose agency and with that the client has a great deal of input into their programming.  

As a case manager for PRIDE the caseloads are a maximum of six clients.  This is to ensure each client is given the right amount of time with their case manager and that the case manager does not become overwhelmed with an extensive caseload.  Plus since each client is on a wavier there is a great deal of paperwork that accompanies each client.

At PRIDE there is never a typical day.  You can plan out your day from the moment you walk into the office to till moment you leave.  But as soon as your cell phone goes off there is a great chance your entire day is going to be rearranged.

The mornings consist of checking in with each client’s staff to make sure that they are following the schedule and that nothing has come up.  In a typical day you will do face time with at least three clients to ensure their needs are being meet.  A meeting with a client can last anywhere from twenty minutes to a couple hours depending on what the meeting is about.

The client’s schedule is made during one of the weekly meetings the case manager has with the staff and client.  Once the schedule is written up it is the case manager’s job to type up the schedule and get it into the client’s LSA (life skills aide) book.

In addition to weekly meeting with the client it is a state requirement that the case manager hold an once a month team meeting.  At the team meeting the client, LSA, home provider, guardian and case manager are all present to discuss the current programming.  This is a great time for the whole team to sit down and just discuss what has happened in the last month and what the team would like to see accomplished in the next month.  Before this meeting the case manager, staff, and client sit down and talk about what topics they want to talk about so it gives the client time to prepare themselves for the meeting.  Once the meeting has taken place it is the case manager’s job to type up a team meeting note.  When the team meeting note is typed up the case manager and client need to sign the note signify that the team meeting did in fact take place.  Once it has both signatures on it the document is then filed into the client’s case manager book.

It is also the case manager’s job to attend medical appointments with the client.  This is ensuring that all important information is gathered from the doctor or given to the doctor.  As with most of the clients at PRIDE they tend to have impairments with their memory and sometimes don’t always remember all the relevant information that the doctor may need to diagnose the illness.  At each medical appointment a medical summary is present to the provider that lists presenting problems and attached is a current medication list (EFS).  EFS stands for emergency fact sheet on this sheet there is the client’s names, social security number, client’s home phone number, home provider’s name, all of the physicians the client is seeing along with their contact number, and a current list of medications with the dosages and the time the medication it taken.  It is the case manager’s job to ensure that prior to each medical appointment the EFS is update so it can be given to the doctor.  When the appointment is finished it is the case manager’s job to ensure that medical summary is filled in by the physician and signed so it can be filled in the client’s medical book.  If any changes to medications at the appointment the case manager needs to update the EFS and make sure the client, staff, and home provider has a current copy.

As a case manager of PRIDE you are responsible to keep contact notes that are due the following Monday morning.  Each client has a current amount of case management hours allotted by the state of Vermont. 

The case managers are also responsible to ensure that each staff has written their weekly note on their clients.  These notes are also due on Monday due noon.  Once each note is reviewed it is filed in the LSA book.  Most of the case manager’s week is spent chasing their staff for the paperwork to ensure that it is done correctly and in on time; but on time isn’t always the case.

Once a month it is protocol for the case manager to pull their client’s books and do a quick review to ensure all necessary documents are filed in the books.  It is important to insure documentation is accurate and present.  The state of Vermont performs periodic book audits.  If documentation is missing or inaccurate the state may take corrective action.

So you would think that case managers at PRIDE only had contact notes, team meeting notes, weekly calendars, and LSA notes to worry about.  Well you would be wrong.  Since each client is on a waiver their funding gets reviewed depending on the client every three or six months.  For the review it is the case manager’s responsibility to prepare documents that the state reviews.  These documents are called independent living assessment, individual services plan, and a rehabilitation quarterly or long-term semi-annual evaluation.

The independent living assessment scores the client in the following areas Physical Development & Mobility, Communication / Cognitive Skills, Eating Behaviors, Food Preparation / Cooking, Personal Hygiene / Grooming, Health / Safety, Social Behavior / Leisure Time, ADL’s and Household Chores, Budgeting & Numerical Skills, Transportation & Travel and Vocational Skills.  The score range from 1-8; 1 meaning unable to perform and 8 being independent. Once the ILA is complete the case manager can see what areas of development the client is struggling in and prepare the other reports.  When it is time to make the goals of what client will work on in the next quarter the case manager meets with the client to get their input.  As PRIDE is a person center based program and greatly appreciates that client’s input on what they want to work on.

In conclusion I was shocked at the amount of paperwork required for case managers at PRIDE.  It is nice to see such a person centered organization where focus is on the client’s goals.  I feel very lucky to be part of such a team that cares so much about their clients.  Each year Michele and her business partner take the entire organization including the client to the coast of Maine for two nights as a time celebrate all the gains in progress the clients have made over the last year.  It is a great time to kick back and relax forgetting the titles of case manager, client, LSA and just people individuals on vacation.   This is usually the only vacation the clients will have all year so it is great to see the smiles and laughs.  

Michele Corrow

The outside of the building 

 

The conference room where most team meetings are held due to the open space

Resources

WWW.PRIDETBI.com

http://www.biavt.org/

http://www.facebook.com/pages/PRIDE-Support-and-Services-Inc/100892889964841?sk=wall

Reflective Listening / Empathy

This week we have been discussing reflective listening and responding in a way that actually helps the client. We also learned the importance reflective listening plays in Case Management. It was great to see what everyone had to say about it and there examples. I can't wait to use these new skills in real life as I know I don't do well with reflective listening as I have a tendences to space out.
I also learned a lot about empathy. I have been told many times in the past this is something I need to work on because there are times I think people would rather be babyed then just work out their problems. I know this isn't the truth about everyone but before I came into this line of work that was my impression. I am glad that I have been able to open my eyes to real needs but I also know at times I lack empathy.