Week 11 question

HBSE: How might your assessment of a client differ from that of another person on your team, such as a nurse, doctor, or teacher?

At first I thought this question meant what would be the difference in questions or in how I conducted the assessment if I were assessing a client compared to assessing a person on my team. I began by suggesting that I change the assessment questions to cater to different lifestyles or education levels.
Then I realized this asked how my assessment of a client would be different than a doctor or teacher’s assessment of a client. I know I still do not have a very broad or defined professional vocabulary compared to a nurse or doctor; therefore this would be one of the first, and most noticeable, differences in assessments. Not only would the wording be different, but also the scope and depth of the assessment. I would not be able to diagnose a client, or really even say what their condition or illness is. Many professionals would get very medical in their assessment whereas I would probably get more personal. I may not go in the same direction as another professional would, nor would I ask as much or dig as much into certain areas of the client’s life.

6-18-08

6-18-08

Wednesdays are fun for most people because we play bingo during the first group in the morning. We had 17 people today, one of our largest groups. While the consumers were playing I went around and assisted some of the people who can not see their boards very well, or who just need help keeping up. There is one female consumer who is not allowed to come very often because she is very obnoxious, loud, disrespectful, and just annoying to most people.

As a social worker we are supposed to try to be indifferent to these behaviors, especially in the mental health field. We are supposed to treat everyone the same regardless of whether they sit quietly or if they act as this consumer does- but it is hard. Especially with a room full of consumers I felt like this one particular consumer was really trying my patience, and just trying to get attention by acting out. When the bingo caller would say a number she would repeat that number, sometimes yelling it out or saying something about the number. She kept talking loudly about everything going on with her, from being in pain, to what she did the previous day, what she will do later that day, her friends, telling jokes, or anything she felt may draw attention.

She decided to be the second bingo caller, yet did not begin calling when she should have because she thought she was going to get a bingo prize for calling. I explained that she does not get one for that but she argued with me about how she was supposed to. Every time she called a number she had something to say about the number. When she called on someone who had a number she said their name differently and tried to use “ghetto talk”. I try not to let her behaviors get to me and I try not to allow my negative feelings for her to come out in my interactions with her. Its one of those kinds of things where someone makes you want to grind your teeth but you still try to smile.

After bingo we worked on a worksheet that evaluated the consumers’ fat, saturated fat, and cholesterol intake during nutrition group. Today was free lunch day so we made ice cream sundaes with all the toppings to go with lunch. It was interesting that the just thinking it was reduced sugar made the consumers not want to even try the ice cream. We also had Diet Cherry Chocolate Dr Pepper, but again just hearing the word diet made them not want to drink the soda either.

After lunch I did current events a little different than I usually do. This time I went through the paper and found articles the consumers would enjoy and read it to them. I would begin the article so they knew what it was about then I asked if they wanted me to continue with the rest of the article. I think they enjoyed this more because they were able to just listen to all the news, and were able to hear and understand everything. Most days when we do newspaper everyone grabs an article and reads it, but some people can not read very well or do not read very loud. This keeps the other consumers from being able to hear or enjoy the actual article.

For the last group of the day we just watched a movie about people reentering into society who have abused drugs or alcohol. It was lecture style where the consumers were able to learn about substance abuse, support groups, and what it is like afterward. We discussed things about the video afterward that the consumers thought were interesting or wanted to point out, such as key points the lecturer wanted people to remember. Some of these were Work on the moment, take it one day at a time, and you must rearrange your priorities.

This was a long and stressful day for Pam and me both. In the morning we had a room full of consumers, and it just seemed like everyone wanted or needed something. I know Pam is feeling stressed and overworked from having to fulfill two different full time jobs at the same time. She is definitely ready for Amanda to come back!

6-17-08

6-17-08

Although Tuesdays are not my usual days to work, I came in because Amanda is gone at a conference. I like working when Amanda is gone just because I feel I get more responsibilities and am usually in charge of more things. When Amanda is here I feel I always have to ask which activities to do, and what she wants me to do next. I still feel like a new student just following her around. When she is gone I often have a choice of which activities to do, and I lead the group most all of the day unless I need something from Pam. I feel like I work harder and am treated like an employee. I also actually feel needed when Pam is in charge, whereas when I work with Amanda I feel like I am just in her way.

As I usually start the day I ran canteen, made the sign in sheet, and started progress notes. The first group I facilitated was about self care skills. We went over a paper together as a group about doing laundry. I would pose each question to the group and everyone would give different answers about how they did things. The first question was when doing laundry how do you sort your clothes into piles? Each person had different ways of doing their laundry, sorting by whites, darks, colors, towels, sheets, and even lights, blacks, delicates, etc. Then we talked about the proper was to do a load of laundry and whether to use hot, warm, or cold water.

When I first started here at Hoosier House I did not have a good perspective on the consumers’ abilities to do what most people consider ordinary daily activities. I quickly learned that I took most people’s daily skills for granted, just assuming that they were able to do things I was used to. I learned how running canteen is considered a way for the consumers to learn daily living skills like money management, or how sticking to the posted schedule helps them learn time management skills. Prior to starting here I would have just assumed the consumers would know how to start a load of laundry, but at this point I know not to assume anything. When I asked the consumers how or where they learned to do laundry many said from the directions on the back of the detergent bottle.

For nutrition group we did a quiz style worksheet about the consumers’ eating habits, and whether they make healthy choices with their food intake. I was able to discuss with the consumers how to make healthy choices when given different opportunities, and how to stay aware of their nutrition and health with daily eating habits.

Next was lunch, then current events where we read newspaper articles. Pam ran the last group of the day while I cleaned up the kitchen and got thing ready for the consumers to go home. I am still not completely used to staying until 4:00 everyday, but I like feeling like I put I a full day’s work. I also like that by working two extra hours a day I am going from 15 hours per week to 21 hours. I feel like I am able to gain a lot more knowledge from Pam than any other employee here, maybe because she just finished school last year and can relate a lot better to me and my role here. During lunch and at other times I like sitting and discussing things she has done, seen, and experienced. She gives me her perspectives on the clients and other things throughout Cummins or our profession.

6-12-08

Today we started with the activity I picked out Wednesday afternoon, a worksheet titled Me, Myself Esteem and I. There were three different categories on the paper; one about their heredity and genes, one about their environment growing up and current, and one about their choices. I gave each consumer an index card for each question and we did the activity together on the board. For heredity and genes we went over (and they wrote on their cards) things about them they were born with. For example, some people wrote their gender, hair/eye color, disabilities, talents, life roles (mother, sister, daughter, etc). This was hard for many of the consumers, and most only wrote certain things that I suggested like the examples above.

On the next card we went over things about their environments during childhood, while growing up, up until now. I again started giving examples of things they could write about, such as if they grew up on a farm, in the suburbs, in the city, during a war, extremely religious, in a religious environment, with a big family, poor, always doing sports, etc. They wrote about their interests, hobbies, favorite activities, and how their lives were and are. This was the one category that most people kept going on and kept finding more to write about.

The last category was about the negative and positive choices the consumer thinks they have made in their lives. We went over positive and negative coping skills, and other things in their lives that contribute to those choices. Each consumer listed a few of both kinds of coping skills, and what they can do to change the negative to positive. Some listed things like smoking, eating junk food, and spending too much money shopping as negative coping skills, and journaling, exercising, and talking to people as positive coping skills.

For nutrition group the consumers played nutrition bingo. The consumers seem to always like bingo, as long as we do not play every day, and enjoy it more when we play various different kinds of bingo. I still always have to make sure to watch out for the prizes since so many consumers still think they can just take what they want without winning.

After lunch we had current events where I cut out newspaper articles so each consumer could pick out an article to read. I always let each consumer take turns reading theirs, and thank them afterward, then I read all the leftover articles out loud. By now I know which consumers like to read which kind of articles, and what each is more interested in. Some like to read only the weather or movie listings, while others like to read gossip about celebrities. No one really likes to read about international matters or sports (unless it’s the Colts).

I let Pam take over after that for the last group of the day while I had a consumer help me sanitize and scrub down the kitchen. The kitchen is obviously used on a daily basis, but is not often cleaned. It may not have been very educational for me, but it felt so much better knowing when I opened a cabinet I would no longer be sticking my hand in a pile of gunk.

One of the regular case workers had a consumer who regularly came in every two weeks when she got paid to go over her bills and make sure things are all paid. The case worker had an appointment to go to and asked if I could assist the consumer when she came in. She left a few things to make sure to do, such as look over all the check to make sure they are written correctly, and make sure everything is written down in the checkbook. The consumer did pretty well on her own, and only need a little direction at times, or my assistance realizing when she made mistakes on the checks she wrote.

This was the first time I was able to work one-on-one with a consumer, especially one who was not a Hoosier House member. I enjoyed being able to assist someone, and feeling needed. I felt like I was her case worker, and that my presence was actually beneficial to her. This gave me a bit of a different experience because even though I was there to assist her, I knew I needed to allow the consumer to try to do everything by herself instead of standing over her shoulder doing it for her, or instructing her. If I had done that she would not have learned anything and the whole point is for her to learn to do things on her own.

6-11-08

At the beginning of the day I was again greeted by consumers during canteen time. I knew this day was going to be different than most regular days since the younger consumers were not in attendance. They often are obnoxious and distracting to the other consumers, so without them there I knew everyone else would actually participate. I began my usual routine of writing progress notes, then organizing for bingo since it was Wednesday, but Amanda first gave us a crossword to work on. I used the board to explain how to complete a crossword because many people had never done one before.

The consumers often have a hard time dealing with the slightest bit of change. So when Amanda handed me new bingo cards to use that had new questions and phrases for the consumers to read out loud, I worried how they would react, and/or if they would even participate or enjoy it.

Instead of 5x5, the cards were accidentally printed 5x4. We ended up cutting it down to 4x4, which interested the consumers more since it gave them more chances to win. Sometimes the consumers will call for bingo, other times, like today, I called.

Bingo is usually pretty easy, but the consumers had problems getting used to this board. Each square has a number and a question or phrase on it. When the number is called the consumer reads and answers the question. These cards had phrases such as “A person who I look up to and would always take advice from”. The consumers did not understand they needed to think of and name someone who fit that quality, they just read the phrase and kept going.

I also have the task of playing security guard to the bingo prizes when they are out. There was a regular couple who used to call every week and decided they both got prizes every time for calling, that they had first pick over the prizes, and could take as many prizes as they wanted. We had to change the rules that only winners received prizes; however, many people still try to just take a prize off the table when they see one they like.

Next was nutrition group, where we went over the 5 food groups. We discussed the vitamins, recommended serving, and serving sizes. I have tried to remember since my midterm to use the worksheets more, and improvise to extend them. After we read descriptions of each food group I had the consumers do short math with me of how many cups or teaspoons they would have to eat to meet the daily servings for various kinds of foods. For example, for fruits and veggies, one needs four servings a day. Each serving size is ½ cup. I asked the consumers to figure out how many cups they would need to consume in one day, which the answer was two.

After I cut out interesting newspaper articles and everyone chose one to read out loud. I have come over time to know which kind of articles each consumer likes, and that they each have extremely different tastes. One person likes to read the weather, another liked news about famous people, another likes the “odd” articles, etc.

For the last group of the day Amanda asked if I would rather watch a video about Clozaril or Schizophrenia. I chose Schizophrenia because I would rather learn as much as possible about diagnosis than medications. I asked the consumers to write three things about the video which they would like to discuss afterward. The video was actually some what boring for most of the consumers, discussing more general things about the disorder that most all of the consumers already knew.

After the video I wanted to do something different to include the consumers and actually get them thinking about schizophrenia. I gave them a hypothetical situation where I was a patient and did not know anything about schizophrenia or what it was. I asked the consumers to describe to me symptoms someone with schizophrenia may have or present. They actually got into role playing where they acted like a doctor and I was the first time patient. The consumers took turns asking questions a doc would ask, such as “Have you felt like hurting yourself or others recently” ?, “Do you hear voices, see things, or smell things that are not there”?, “Do you feel like others are out to get you”?, etc.

This was a fun activity because the consumers had a chance to show how much they actually knew, and to feel for once like they were the experts. Everyone got into describing symptoms, and said when we were done that they would enjoy doing it again.

I stayed late to make up hours for missing Monday, and this was the first time I stayed the entire day. After the consumers left I had time to organize several things around Hoosier House that were in need, such as the back room with bingo prizes and all the videos. I also went through an activity binder to find activities for the next day.

6-1-08/ 6-5-08

6-5-08 This has been my first full week back to work since school ended. Even though I had about two weeks off, as soon as I walked in the door on May 28^th I got right back in the groove of things. I had a large welcome from every one of the consumers, and could tell they were excited to see that I was still there. June 2nd started a new week, and a new beginning, where I wanted to prove I would improve and do better than I had before. I have always worked M, W, and Th from 9am-2pm, but since it is the summer now and my son is out of school I offered to change my hours or days for whatever would be best for Amanda. In another week she will be going to a conference for four days, so I offered to work each of those days to assist Pam while she was gone.

Every morning when I come in to Hoosier House I run canteen. Canteen gives me a chance to talk with the consumers and get updates on their lives outside of Cummins. They tell me about their outings, families, and lives. Through this I can do a quick appraisal of how the rest of their day may go; someone may be in a bad mood, may be having elevated symptoms of their disorder, may be dealing with a recent tragedy, or just needs more praise and attention through the day. I learn to adjust the way I deal with each individual based on these quick assessments.

One female consumer is very shy so when I first see her I always give her a big greeting to make her feel welcomed, and I know I can always carry a conversation with her outside of group, yet she does not like to read out loud or be called upon during group. Another consumer always comes in to talk to me the days he is there. He seems to keep claiming elevated symptoms of medical problems, yet never shows signs during group. His own doctors have said they do not believe he has the problems he claims, yet he still tells us when he is having attacks. The very first time I heard this from him I became extremely concerned and did not know how to handle it, so I discussed it with Amanda. Now I know his behaviors so I just humor him at times while trying to still inform him I did not witness any signs of it because I do not want to add to his delusions

Most of my days seem routine since I have the same consumers, and do the same activities. At times I try to incorporate different activities, but they are not always welcomed by the consumers. They are so used to their routine and do not like deterring from it. Thursdays are Amanda’s administrative days so Pam runs group. This previous Thursday Pam was late so Amanda gave me a book of activities and asked me to pick which one I wanted to do. I chose one where the consumers had the letters of the alphabet listed and had to write one good thing about themselves that started with each letter.

They all had obvious problems with this, many not knowing words for each letter, or feeling apprehensive about writing good things about themselves. After they were done they turned the pages over and took turns trading papers with everyone else in the room. Each person had to write one good thing about everyone else. This was a little easier, yet some consumers complained about not having good things to write about certain other consumers. Some wrote generic comments such as they are nice, or they merely repeated what someone else had already written. I still enjoy trying to get them to participate in new activities, and to get them to learn new things about themselves. I guess it just takes time, and a little more work on my part to get them involved and comfortable with the idea.

In retrospect, I see the need for continual blogging/journaling during the week, as it is easy to forget simple interactions and educational experiences in one week's time. As I try to recall a full day's work for each day of a week's worth of work, it all seems to flow into a jumbled memory. It is hard to write about individual encounters or certain incidents in as much needed detail when it is a full week after it happened. I need to work on making a regular schedule to blog, and to figure out better how to go about it. I think writing daily would be too much, although waiting an entire week becomes too general and in my opinion does not explain my experience well enough.

I also am having a problem with how much or how far I can write about people or experiences in group. I know I cannot name names, but when it comes to a person's disorder or things that happened, I am not sure how much detail I can write without breaking confidentiality. I know this blog is an educational tool to write about my experiences at my practicum, but I must consider that this is a public venue. So how much is too much?

I also need to just write directly in my blog instead of keeping it in a file, then adding it later. I think it is good that I realize and discuss certain things that I need to work on that way I do not fall into my same old habits and get behind.I know I still have many things I need to work on to become the excellent student and social worker that I wish to become.

A New Beginning

5-22-08- I figure since I am starting a new chapter in my practicum that I should sum up my experience thus far, then come back every week and reflect on my experience as I am supposed to. Just to avoid confusion, if I discuss people at my practicum I will make up an initial for each person to refer to them by.

So when I first began my practicum I wasn’t scared as most other students were, nor was I worried if I would do alright. I was, however, apprehensive as to whether I would have a good experience, or whether I would learn enough or what I needed at Cummins. I was confident in my interactions with my clients, but I was not sure how I would be perceived by my supervisor or coworkers.

The first week I felt more like a guest than an employee, where I participated in the consumer activities like bingo. I quickly began to build relationships with the consumers, careful to make sure they saw me as an employee/intern rather than a friend. I think this has been one of my biggest challenges in the field as I am used to always befriending everyone I meet. I definitely learned the difference between the role of a social worker and a friend.

I felt like an assistant, where I just followed my supervisor, Amanda, around, doing little things and running canteen. Over time I learned how she did paperwork, and procedures that were used for different situations. There was a daily schedule of activities that we always followed because if we deterred even a little the consumers were quick to remind us what we were supposed to be doing. I knew they came to Hoosier House to have structure during their day, but I did not realize how much they depended on that same structure.

It was not until Amanda had surgery and was off for two weeks that I really stepped up and became more productive. Pam, a case manager, was in charge during this time, but usually had me run things so she could work on her cases. During that time I began filling out the morning paperwork, and was in charge of making sure everyone completed it. I always ran canteen every time it was open, and I began making lunch every day for the consumers. Although I was provided the materials and activities for group, I actually ran group every day.

I saw the difference in how my role changed during those two weeks, and I saw the difference in how the consumers saw me. At first I was just the intern, a helper, but then I turned into a leader, the group supervisor. They looked up to me, and came to me for things.

I also was able to start telling the difference between the consumers’ regular actions and behaviors, and those that were a result of their illnesses or disorders. I was learning what severe mental illness each person had based on their actions and behaviors, and I could tell when someone’s behavior was a result of their disorder. I began learning more about mental illnesses, and all the different presenting symptoms they have.

Once Amanda came back I actually felt awkward because I was not sure how to be. Before she left I was just a helper, but while she was gone I became the leader. When she was around I was used to just following her direction, but by then I was used to taking charge and running everything. We soon got back in a groove where I still ran things, and she just gave me the paperwork for the activities.

In all this time I saw myself become a practicing social worker. I was in situations that seemed oddly familiar, then realized it was because I already learned what to do from my coursework. I remember learning about identifying a consumer's goals and objectives in S231, but I just thought it was part of procedure and I would not use it in my real practice. However, while working with a case manager at Cummins I found out they use this exact system with their clients. The paperwork I fill out every morning for them identifies the goal and objective that each consumer is working on while at Hoosier House.

There have been so many individual situations I have experienced at Cummins that have just reinforced my learning at IUPUI. So far, this practicum has been a valuable learning experience, and I look forward to learning even more in the coming weeks.