Assignment 4

I have met with JB already quite a few times and what i have been noticing is that the goal she has set for herself with losing weight is "not working out" as she has put it. I as her social worker am working on in exploring her feelings and concerns of why is it she feels too overwhelmed with this goal.

Pre-engagement:

JB has been feeling frustrated and uncomfortable with writing out her daily meals on a monthly calendar because she is embarrassed about her spelling. Client also has gained back the 3lbs that she has lost and feels as if this plan is not working out for her. I had suggested looking into a gym where she can exercise in addition to which client did not oppose to. Client then informed me in the coming days that her mother will not pay for it.

Narrative:

JB has informed me before our session the refusal of her mother paying for her gym. I will take this opportunity to explore with my client why she feels “stuck” and cannot get motivated to reach her goal.

-          Hi JB, how are you?

-          I am good thank you.

-          Before we get into what you told me few days ago, I would like you to tell me first about this independent living program you are attending, you haven’t mentioned that to me…

-          (Laughs) yeah, I’m doing this program for awhile now since September. It’s one year and after that I can apply to independent living.

-          I didn’t know you were interested in living on your own. Tell me more about that.

-          Well yeah I didn’t get a chance to, but it’s all a part of what I want to change about myself.

-          So this independent living, is that subsidized housing from the city?

-          Yeah.

-          So you will be paying rent?

-          (Takes a big sigh and looks down) Yes…

-          What is that sigh; tell me what you are feeling?

-          Well, I know what you are going to say?

-          You do?

-          Yes

-          Please tell me…

-          You are thinking how is it that I’m going to live on my own if I don’t even work…

-          Well JB, that did cross my mind, but why did you sigh like that?

-          Well, because I’m really trying hard…

-          Do you remember last week when I was not in the clinic because I was sick and we met the following week and I asked you “so tell me about your week”?

-          Yeah…

-          Do you remember what you told me?

-          That I watched TV …

-          Right. All you mentioned was that you watched TV, listened to music and that was it. You never mentioned to me about you trying to look for a job…

-          (continues to look down) I know…

-          (I stay quiet, and give a moment for JB to gather her thoughts and open up more)

-          I’m really trying, but it is just so hard…

-          What is making it so hard?

-          I can’t do everything…

-          Ok let’s try to break this down. When we first met you told me that you are looking for a program, which by the way I need you to sign a few papers before I submit the application to the agency. And also you said that you would like to lose weight. Let’s put the independent living program aside for a minute and talk about the nutritionist.

-          Ok.

-          You mentioned that you gained 3 pounds and do not feel like this is working...

-          Yes because I feel uncomfortable writing these words, what is the point to this.

-          I’ll tell you what the point is. First of all in order to lose a certain amount of weight you really need to commit yourself to this goal.

-          I am…

-          Please hear me out first JB

-          Ok

-          And second if you are having a nutritionist guide you with this weight loss, she needs to know what you eat every single day for one month because this gives her enough information to tell if you are eating right or wrong.

-          I know…

-          And you must also understand JB this doesn’t work over night. It entails a lot of commitment and a lot of will power.

-          I know…I’m really trying.

-          I believe you. Before we continue let me quickly go bring you the forms to sign…

I walk back into the room and notice that JB is crying:

-          JB, are you crying?

-          I’m sorry.

-          Don’t apologize, why are you crying?

-          (shakes head) I don’t know, I just feel like such a failure…

-          Did I say something to upset you?

-          No you haven’t…

-          So talk to me what brought this out…

-          I’m really trying to change and you know my mom doesn’t want me to do the gym thing because she feels I don’t need it. And that’s fine, but everything else like the weight loss and finding a job it’s just so hard. And I am really trying.

-          JB, I want you to know something, I had no idea you were doing this independent living program and you told me that you have been coming into the clinic once a week since September. I’m so proud of your dedication. This comes to show me that you can do anything else.

-          I can…

-          Yes you can. And I want us to work out a schedule, would you be ok to my suggestion…

-          Yes ….

-          Ok, here is what I think you and I can work on. I want you to set a time frame for yourself. For example, by August I have to lose 5 pounds and I want you to record every single day your weight. Do you have a scale?

-          No I don’t (laughs)

-          You don’t? Well JB, you will have to get one. They don’t cost a lot and this I want you to get.

-          I will, I will.

-          Good.

-          And from now until August I want you to aim for that goal. Once august comes around and you have lost those 5 pounds you will aim for another 5 lbs until November, giving you only 3 months to do that. Do you understand what I mean?

-          Yeah.

-          Good.

-          And this way you are focusing on this and look at your scale everyday and see “oh wait a second I gained a pound, I must be doing something wrong” and this will give you motivation…

-          Yes I have to I have to…

-          Now also JB in addition there are a lot of other things you can do, and like I mentioned last week perhaps not the gym, but you can easily walk, jog or anything else you want to do. The weather is picking up and you will see once you put yourself to do this, it will get easier.

-          You are right, I have to, I must.

-          No excuses JB…

-          None. I can do this.

-          Also you are still to do what your nutritionist asks, my suggestion is separate.

-          Ok.

-          And I want you to do something for me. I want you to write me same thing you are doing for your nutritionist but include the time when you eat last. And no cheating. I want to get a better understanding and if I feel that cookie is getting in the way, you will have to try hard to eliminate that cookie. Do you understand?

-          Yes.

-          I know you can do this.

-          Thank you, I can.

Impressions:

JB has been feeling a little overwhelmed because of all her goals that she set for herself. She was frustrated with the nutritionist plan because she felt there was no point to it. I tried to help JB understand that in order to be motivated and achieve her goal she must be committed. I will help JB get motivated, but the commitment is something that has to come from her. At the end of our session I felt as if she realized that without committing herself she won’t achieve it. In our coming session I will look into her meal plan and talk over with her where she thinks she might not be getting the results she is hoping for. 

Assignment 3 - Updated

I’ve selected Mrs. A. for my intervention project, but I can no longer use her because she has been having some family problems and have missed coming to see me for 2 weeks. Since this is not reliable for me I have decided to switch to another client with whom I feel I established a very good relationship with.

JB is a 28 year old female who lives with her mother and younger sister in Brooklyn, NY. JB is from a Puerto Rican descent and is bi-lingual in Spanish and English. JB attended a special school until she graduated at age 21. Since that time JB has had no daily structure and would stay at home most of her time. JB is diagnosed with Obesity, Asthma and Moderate MR.

When I first met with JB I had asked her very basic questions to get a sense of who she is and in that time I have noticed that JB has a very poor eye contact and kept looking down the entire time as we were talking. JB presently to be very “medicated” and by that I mean she took her time to speak and spoke slowly – to which I later found out that she takes medication that makes her less anxious and more calm. JB also presented to have a difficulty distinguishing between days from months and months from years. Aside from these conditions when I asked JB about her goals she had mentioned that she wants to change her life by starting to lose weight. In addition she wants to find a day program so she can do something during the day instead of staying at home. I told her that all of these goals are realistic and I would help her achieve these goals with the period of time that I will have with her. Her only complaint was that she wants all these goals, but she can’t manage coming in to her appointments. I told her that she should look at these appointments in this way: as a way of getting out of the house and one step closer to achieving her goals.

My intervention with JB is to plan her schedule out ahead of time and write down all of her appointments on the calendar – this way she will be motivated and will have a way of keeping up with them.

Assignment 2

After thinking over my clients I have chosen Mrs. A to work with for this project.

Mrs. A. is a 55 year old female who lives in Brooklyn with her daughter and husband. Client is diagnosed with Asthma, Speech impairment, chronic depression and Mild MR. Client has an ongoing issue with her health insurance due to problems at home with her husband. He is the head of the household and since there is poor communication he does not cooperate in the process of the renewal. Client does not have a psychiatrist and has not had either a psychosocial or a psychological evaluation done. The daughter as well as the husband are both developmentally challenged and have speech impairment.

            Mrs. A. is beyond frustrated with her husband because of their lack of communication. Her daughter is very sad to the fact that her father doesn’t communicate with either one of them. And if he does he upsets the daughter – which results in her crying. Mrs. A. is fed up with him that she is considering leaving her husband. When I asked Mrs. A. where would she go and how they (her daughter and her) live – she had no answer. Every session that we have, Mrs. A. is anxious, frustrated and annoyed with her husband. I believe that although she has these emotional feelings – she does not have a plan.

            From observation Mrs. A. is suffering from anger. Every session she is angry and frustrated. This type of behavior is “overt”. After mentioning to Mrs. A. that I am doing a project on her she was very excited to hear that I chose her as my project. I assured her that her name will not be disclosed. In addition I asked her to keep a journal and record daily on a scale of 1 to 10, 10 being the most furious she can be how she feels daily. And in addition I have asked her to also record the frequency in which she feels this way daily – what are the triggers and how he copes with her anger.

            I am looking forward to seeing her results. Will post back.

My Agency (Blog 1)

Assignment #1 – My Agency

I work in an agency called PHC. My agency is a multispecialty clinic which has many physicians from internal medicine, pediatrician, psychiatrist, psychologist, social workers, Occupational therapist, Physical therapist...etc. This clinic only takes straight Medicaid and nothing else. My population is mainly developmentally challenge young adults who suffer from CP, MR, autism and many other physical and intellectual challenges. Most of my consumers are caregivers because a lot of the clients are very little from 7-14 years of age. And in addition a few of my clients are over 45.

My role in the placement is to provide case management services to families and individuals. I make sure that before I proceed in helping them obtain Medicaid Service Coordinator all of their psychological evaluation, psychosocial and physical exam are new and upto date. If families are asking for services and none of these requirements are upto date there will be a delay in obtaining it for them.

Since my clinic is multispecialty almost every room in filled up. Because of that majority of my clients I don't see and have to deal with over the telephone. That has been the biggest struggle for me because I don't know them completely and they resist talking over the phone. But luckily now I have 2 new clients with whom I will be providing supportive counseling to weekly until May. So I will see them in total of approximately 10 times.

            The goal of these new clients is to relieve their depression and help provide support in their struggles within their family dynamics.