Week 15

There isn't much to blog about this week. Most of my activities have been dedicated towards wrapping up my work with the patients I have been working with. It feels both good and sad to be finishing the semester. I am glad that I have successfully completed my work but a part of me will miss the patients I have become familiar with the last four months.

Activities -

• Finished up last minute learning plan details
• Started the termination phase with patients
• Attended rounds
• Attended treatment team meeting

Practice/micro: How have you experienced successful endings? What do you already do now to help your clients experience successful endings?

Prior to this semester, I hadn't worked with patients in a clinical settings. As a result, I didn't anticipate how it would feel to bring our time together to an end. However, I did get the chance to terminate a relationship with a patient in February, which helped me come to terms with what it feels like to move beyond the relationship with a patient.

Towards the end of February, one of the patients I was working with was suddenly transfered to another unit. As a result, I had to bring an end to our time together and deal with the emotions of ending a relationship that I had become fond of. The patient was someone who I got to know quite well, and she and I spent many hours discussing her problems and feelings. When I was told I would have to end my relationship with her, I was saddened. I hadn't realized that I had grown comfortable with our relationship and enjoyed working with her.

My first question to myself was "How will I successfully end our relationship?" I thought back to the readings I had done and made a list of appropriate ways to terminate our working alliance. With that information, I was able to truthfully explain to her why we had to end our relationship and we discussed how this made her feel. Even though I was saddened by our time coming to an end, I didn't allow that to influence how I ended the relationship. I focused on her feelings and we discussed some future goals that she might work on with her new treatment team.

I believe that I ended our relationship together appropriately. I truthfully explained why we had to discontinue working together, was concerned about her feelings, and helped her to make a few preliminary goals for the future. We also discussed some of the progress she had made since entering the hospital. In doing so, I believe I helped her to reflect on what we had accomplished together as well as facing her feelings about moving forward. Furthermore, I feel that it was a good learning experience as I will have to end my working relationship with the three other patients I am currently working with. I now have a better understanding of what to do and say to bring closure to a professional relationship.

Total Hours this week: 17 hrs
Total Hours to date: 220 hrs and 30 min

Lunch and Learn

I attended a Lunch and Learn hosted by Eli Lilly. The topic of the discussion was mental illness and how certain medications are withheld from patients' due to the high cost. The speaker discussed how insurance companies dicate what treatments patients receive.

I found it imformative to learn about the different medications that can be used and how insurance companies refuse to pay for medications that are expensive, even if they work. Furthermore, it was interesting to hear a medical doctor's opinion on the issue with medication and patient treatment.

As a social worker, I find it alarming that patients are denied proper treatment because of the financial cost. We believe in advocating for what is best for the patient, no matter the cost. I can see how difficult it must be to work in a profession where treament is dictated by companies that only see the bottom line, which is profit.

This meeting was insightful and interesting. I find it interesting that drug companies will bring free lunch to hospital employees so that they will listen to their presentation. I learned something but realize that Eli Lilly also has the same bottom line as the insurance companies - to make a profit.

Indiana Medical History Museum ( Central State Hospital)

I visited the Indiana Medical History Museum with a few collegues and was intrigued by what I saw. The museum was originally the pathology department for the Central State Psychiatric Hospital, which closed in 1994. The building dates back to the 1890's and was filled with fascinating items such as brains in jars, an autopsy table, antique books, etc.

It was really neat to see how psychiatric care progressed during the first half of the 20th century. Techniques were often primative and grueling. The technology deffinately left something to be desired. I found it both fascinating and awe inspiring to take this look into the past.

Larue Carter Funding

Larue Carter, being a state psychiatric hospital, is mostly funded by tax dollars. However, when patients are admitted, their financial information is reviewed and it is determined if they can pay for treatment. If patients have private insurance, medicaid or medicare, those my pay a portion of the patient's visit.

Many people believe that because Larue Carter is a state hospital, Indiana Residents are automatically afforded treatment. This is not so; even the patients that don't have the means to pay will receive a bill. Many times, the bills are written off because it is impossible for most patients to pay for treatment that can reach into the hundred-thousands. Thus, taxes from the state make up the difference.

Week 14

Well, things are wrapping up. It's hard to believe that the 14 week is over. When I started this semester, I thought it would last a lifetime!

Activities -

This was an eventful week.

• Conducted process recording
• Worked with three patients
• Attended rounds
• Studied public policies that affect Carter Hospital
• Compared the difference between a psychologist, psychiatrist, and social worker
• Transcribed and completed process recording

Research/micro: What are the ways you can evaluate your practice with clients?

There are many ways one can evaluate the practice that they do with their clients. I am a firm believer that in order to be affective, one must be willing to make changes to his practice and be aware of what works what doesn't. Some method to determining evaluation include client surveys, client satisfaction, and observing changes in client's behaviors and attitudes. If there isn't a measurable change, chances are the work that was done didn't have a positive affect.

In order for a helper to stay effective, it is important to be aware of new treatments available and to stay current on new research. If one gets stuck in the old way of doing things, one's practice will become outdated and possible ineffective. I believe it is also important to seek regular supervision from seasoned practitioners. The bottom line is that any professional should regularly observe and update his practice to best help the clients served.


Total Hours this week: 20 hrs
Total Hours to date: 203 hrs and 30 min

Week 13

Things are winding down and I am tying up loose ends at Carter. My goals for last week and the rest of my time at Carter are to finish up the process recording, put the final touches on the learning plan, and wrap up my relationships with the patients I have been working with. There are three weeks left to work with the patients and I hope I can make a lasting impression and bring our time to a proper end.

Activities -

• Daily Rounds
  
• Lunch and Learn (sponsored by Eli Lilly)
• BSWSA Board Meeting
• Planned for Process Recording
• Met with three patients (6 sessions total)
  
• Put a few final details on learning plan

Integration question:

Values & Ethics/micro or macro: Describe an ethical issue, concern or dilemma you experienced in the field. How was it resolved?

One of the issues I have been concerned with is the treatment that persons who are severely mentally ill face. I am not referring to the treatment by staff members but the treatment by society. Many of the patients at Carter aren't getting better with treatment and I wonder why they have to stay in an institution. For example, I am working with a patient that has schizophrenia. He is very ill and doesn't understand that he is mentally ill. He wishes to leave Carter and I can't help but feel empathy for him. What is the point of him staying there when there isn't anything more we can do for him? I wish there was a place people like he could go where they could live out some sort of meaningful life.

I blame society for this issue. In a time when our bank accounts are a growing concern we push for lower taxes. But at what costs do lower taxes come with? The people that are the most mentally ill don't get proper care and the State can't afford to give them a quality life. As a result, they are stuck in an institution that merely maintains their existence. Shouldn't they have a chance to live a life?

This isn't a concern that has been fixed; I am not sure there is a solution, but I think we, as a society, need to try and have more concern and empathy for the mentally ill. What if it was someone we loved stuck in a psych hospital? Wouldn't we want them to have the best care or a chance at a descent life? When we advocate for lowering taxes, we need to be cognisant of where that money is being pulled from. I don't understand why we advocate for lower taxes, less care for the mentally ill, and larger, more expensive stadiums.

Total Hours this week: 16 hrs
Total Hours to date: 183 hrs and 30 min

Week 12

Activities -

This week was filled with exciting events and activities. Some of those include:

• Treatment team meeting
• Scheduling of process recording
• Mortality review
• Visit to Central State Hospital

Integration question:
HBSE/Macro: How can you determine what the formal and informal boundaries are in a community?

Informal and formal boundaries are quite common in groups and communities. Informal boundaries refer to those boundaries that are flexible and don't have definite parameters while formal boundaries are those that have clear, definable limits.

In communities, for example, one can determine the formal and informal boundaries by assimilating into the community. The physical limits to the community may be informal. There may be several different streets or neighborhoods that blend into the community. Moreover, there may also be formal boundaries such as the way the elderly are treated. Some communities have formal boundaries in that the elderly are treated respectfully at all times while other communities may have less formal boundaries that fluctuate.

Similarly, many communities may be closed in the sense that only allow a certain ethnicity to participates in the community. This would be an example of a closed boundary. Furthermore, many communities have open boundaries that allow many ethnicities and cultures to mix.
Whatever the boundary system, one most work directly with the community in order to best conclude what formal and informal boundaries exist.

Total Hours this week (including 2 seminar hours): 19 hrs and 10 min
Total Hours to date: 167 hrs and 30 min

Week 11

This week's post will be pretty short as I was ill and didn't attend practicum. Therefore, this post will focus on the integration question.

Integration 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 Larue Carter, there are many assessments of patients; nurses, psychiatrists, psychologists, etc. all have their roles and complete various evaluations. Psychiatrsists are primarily concerned with the medical treatment of psychiatric disorders. Therefore, several distinctions exist between psychiatric and social work assessments.

When a psychiatrist evaluates a client, he/she focuses primarily on the patient's medical health. The assessment might include an evaluation of the general physical and mental health of the client. The social work assessment, on the other hand, may also include such areas as social, emotional, and/or physical assessments. The social work evaluation aims at looking at the entire picture of a client's life while the psychiatric assessment may focus exclusively on the patients medical health.

Obviously, each psychiatrist and social worker is different and thus so will be their evaluations. Therefore, it isn't possible to say for certainty what one's evaluation will entail. However, the medical profession specializes in treating a client from the medical perspective while the social work profession utilizes a number of perspectives in order to help a client. Psychiatry is quite specialized while social work can be quite broad. Even though there are similarities between what a psychiatrist and social worker do, definite boundaries do exist in each profession.

Treatment Team Meetings

Since I have been at Larue Carter, I have attended a number of weekly treatment team meetings. The goal of the meetings are to evaluate patient progress and to update the patient's medical and psychological treatments. The meetings consist of the unit psychiatrist, unit charge nurse, unit director, unit social worker, and unit psychologist. Family members of the patients are also welcome to attend.

During my tenure at Larue Carter, we have seen a number of patients and made many changes to their treatment plans. All professionals responsible for working with the patients have equal input into what changes are made. The psychiatrist is responsible for the medical needs of the patient, the psychologist is responsible for the psychological needs of the patient, and the social worker is responsible for the social needs. Furthermore, the nurses that attend give great depth into what is happening in the daily lives of the patients. This information helps the treatment team to make the best choices for everyone involved including all patients, the staff, and family members.

From my point of view, it has been quite interesting participating in these meetings. I have seen just how dedicated the hospital staff is in the treatment of patient's and recognize the effort they put into choosing the best treatments possible for the patients.

I have enjoyed being a part of these meetings and now understand just how much time and effort goes into helping patients maintain their illnesses.

Psychosocial Evaluations

Psychosocial evaluations are assessments used on clients that obtain general information such as employment background, financial information, family history, medical history, etc. Larue Carter utilizes the psychosocial evaluation and it is the responsibility of the social work to complete the assessment. In my opinion, the psychosocial evaluation is a useless tool because it barely goes beyond the surface and merely is repetive in nature.

The psychosocial evaluation isn't beneficial in a number of ways. It does obtain a general background of the patient's life, but doesn't go in depth enough to give needed information. Furthermore, the psychosocial evaluation merely repeats what other assessments have already stated and seems to be an unnecessary task. The psychosocial evaluation does have a section for the social worker to write in strengths of the patient but doesn't guide the social worker in identifying strengths. Thus, the psychosocial evaluation isn't strengths focused.

I feel that there could be a better use of the social worker's time. The psychosocial evaluation asks information that has already been obtained by other professionals, and therefore is pointless. Moreover, I feel that a strengths assessment would be more beneficial to the patient's treatment and recovery. I feel as though the social worker has a lot more to offer in the ways of strengths assessing.

Week 9

This week was similar to other weeks. I worked with clients, completed research, attended a group, and completed a psychosocial evaluation. I was a busy week and I anticipate that the following weeks will speed up.

Activities -

• Completed psychosocial evaluation on patient and interviewed family member.
• Attended Cognitive Distortions Group
• Participated in treatment team meeting
• Worked with 3 patients
• Researched Borderline Personality Disorder in the Larue Carter Library

Integration question:

Policy/macro: What are the time frames needed for developing a treatment planning your agency from the time that the client enters your program. Who dictates that policy?

From what I have learned while being at Carter, there is no set time that the treatment plan has to be done. Each member of the treatment team has a different time frame for completing their part. For example, the social workers are required to have the psychosocial evaluation done within a week of the patient's admit date. However, it often isn't completed in time because it can be hard to get accurate information in a week.

With Carter, treatment planning is an ongoing process. Even though there might be a preliminary plan that gets completed, the plan is updated and changed frequently. Treatment is an ongoing process at Carter and can change greatly due to the nature of the patient's mental illness.

The policy is dictated in part by DMHA (Department of Mental Health and Addictions) and mostly by the Clinical Director. However, each department, (i.e. psychiatry, social work, nursing) has a different time frame depending on what needs to be accomplished.

Total Hours this week (including 2 seminar hours): 17 hrs and 30 min
Total Hours to date: 148 hrs and 40 min

Week 8

This week, I continued to work with the clients from the following week and worked on blogging. I also completed my Midterm Evaluation.

Activities -

• Blogged
• Worked with clients on establishing goals
  
• Attended Rounds meeting on Wednesday
• Reviewed past psychosocial evaluations of patients
• Researched psychiatric disorders in the DSM-IV

Integration question:

HBSE/micro: What theories of development would be useful for you to know about in your field placement?

• Erikson's Theory of Psycho-social Development
  
• Freud's Psychodynamic Theory
• Bandura's Social Learing Theory
• Piaget's Cognitive-Development Theory

Total Hours this week : 16 hrs and 50 min
Total Hours to date: 131 hrs and 10 min

Week 7

This was a pretty interesting week. I got to start working with a patient that I did a psychosocial evaluation on the week prior. We developed starting point for a professional relationship and she was willing to discuss her issues/concerns with me. I am looking forward to working with her over the next 8 weeks.

Activities -

• Interviewed patient
• Attended Diversity Fair
• Participated in Treatment Team Meeting
• Continued working with male patient
• Read DSM-IV sections on Schizoaffective disorder, Bipolar disorder, and Schizophrenia
• Initiated contact with new patient

I met a new patient that my supervisor wants me to follow. He is a difficult patient because he doesn't want to talk and when I have tried to initiate conversation he states he doesn't want to be bothered. Because I am an eager student, I want to "dig in" and start working with patients. I am frustrated that this patient doesn't want to talk but understand and respect his right to choose to keep to himself.

Reflection -

In working with clients, there are many characteristics that a social worker needs in order to be most effective. For example, Lawrence Shulman states that "empathy, relevant self-disclosure by the therapist, and facilitative confrontation, appear to positively affect outcomes" (Shulman, 1978). In other words, Shulman's research has demonstrated that being able to place oneself in the shoes of the client, disclosing relevant information to the client about the worker, and confrontation that is beneficial to the client all can lead to a better relationship between client and worker/therapist. The better the relationship, the more affective the time spent together.

I believe it is important to note the difference between skill and trait. A trait is an inherent part of a person's personality and a skill is something learned that can be applied in some way. Empathy, for example, can be both a skill and a trait. Some workers might have a natural ability to feel what the client feels, and some may have to learn how to step aside and see the world from the client's perspective. Either way, skill or trait, there is still much to learn. A worker cannot rely solely on skill without having some sort of personality trait that directs the skill in a positive direction. Similarly, relying solely on a personality trait can be ineffective because without technical knowledge, one may wonder into unknown territory and not know how to navigate. In my opinion, it is best when a social worker strives to gain skill while also working to bring out positive personality traits.

References:

Shulman, L. (1978). A Study of Practice Skills. Social Work,
23(4), p. 274-280

Total Hours this week : 14.5 hrs
Total Hours to date: 114 hrs and 20 min

Week 6

There wasn't too much out of the usual this week. I did, however, get to do my first psychosocial evaluation with a patient family member.

Activities -

• Psychosocial evaluation
• Attended Carter/gatekeeper meeting
• Attended Diversity Luncheon
• Met new patient
• Continued following male patient

Learning -

With completing the psychosocial evaluation, I learned that it is sometimes difficult to get accurate patient information. A social worker, in many ways, has to act as researcher tracking down information from the client, family members, etc. It is not always easy and information is not always available. I learned to be patient and accept that there is only so much I can do. I look forward to doing another evaluation.

Reflection -

There are many things a social worker can do at the macro level to impact human rights. For example, one could organize an interest group for a particular issue or policy. One could also lobbying to local, state, and national legislators directly, Similarly, a social worker might teach awareness workshops which could encourage society to rally behind his/her cause. There are almost an infinite amount of possibilities, and social workers have the knowledge and expertise to advocate for individuals in a multitude of ways.

Total Hours this week (With Seminar 2 Seminar Hours): 18 hrs and 50 min
Total Hours to date: 99 hrs and 50 min

Care Providers

One of my experiences at Larue Carter thus far has been to participate in care-provider meetings with patients and prospective care-providers. I witnessed several care-providers come and give their sales pitch and tell the patients what they could offer. The patients then went on the decide who to go with. I am concerned and appaled at this process.

Care providers provide housing, employment, and medical/behavioral assistance to clients who are reintegrating into society. The way Indiana is setup, several care providers are sent to the client(s) where the clients interview and decide upon who they wish to go with. What ends up happening is the care providers basically "sell" their company to the clients and the clients alone have to choose who to go with.

With state laws, case managers aren't permitted to influence who the client chooses. Even if the case manager knows something terrible about the care provider, they cannot influence the client's decision. Theoretically, the client is supposed to interview the care providers and choose who he/she feels is the best match. However, there are several problems with this. One, many of the clients who require the services that a care provider offers don't have the intellectual capabilities to choose the best provider. Thus, the provider knows this and plays on client weaknesses, such as offering to take them to McDonald's, etc. Many times, clients end up choosing who they like best, based on what trivial things were promised and not who really is adequate in providing services.

To get to my point, suppose I am selling a car to a person. Ideally, that person has the capability to ask the right questions in order to choose which car is best for him/her. However, try selling a care to a mentally handicapped person, and they may likely choose which one they feel has the "prettiest color" and not necessarily which car is the safest or most reliable. Thus, they don't always have the intellectual capabilities to ask the right questions and companies know this and manipulate in order to be chosen.

Why doesn't the state step in and fix the system so that it is more fair to the clients. I was told that the state wants to be fair to the providers and fears that if the case managers influenced the decision of their clients, they might steer business towards a company they had a personal stake in. As a result of this theory, all the burden is left to the client in determining who to choose.

Case in point: At Larue Carter, we have three deaf/MRDD (mentally retarded) patients that are being discharged and moving together. They had to choose their case manager, interview three providers, and come to a unanimous decision on which provider to go with. I watched the entire process. Three different providers came in, promised that each client would have their own room, own television, be able to choose the color of the walls, etc. Each company knew what to say in order to sound appealing. In theory, the clients were supposed to be able to "interview" these providers, but being MRDD, only asked basic questions such as "Where will we eat?" Can I play Mario?" and "I like the color blue!" In the end, the clients chose the company who had the most flashy props and promised the most entertainment and food outings. Because I have a conection with the company who oversees the care providers for the state, I was able to inquire about the company that the clients chose. I was told flat out that this company was horrible, didn't have enough staff, and was probably one of the worst. What could I do with that information? Nothing! Even if I had known ahead of time, I wouldn't have been permitted to say anything. Remember, the burden is placed entirely on the clients to choose who was best.

My point with this is, who is the state looking out for? Here are three people that chose a company that has been proven to be lacking in many areas and yet the system that is set in place allowed for that company to be chosen to care for these individuals who cannot care for themselves. The state is worried about competition for the care providers to the point where they have set standards that cannot be met by the individuals responsible for choosing the providers. It is probably obvious that I am saddened, appalled, and disgusted by what I consider to be exploitation of a vulnerable population.What can I do? We will see!!

Diversity Luncheon

On Wednesday, February 13th, I attended a staff diversity luncheon at Larue Carter. It was neat to see people from different cultural and ethnic backgrounds come together to share their favorite dishes. As I sat back and watched the people interact, I noticed how unimportant diversity really was at this lunch. And I say that in the sense that everyone came together as humans and collegues and not as different people from different races, religions, or ethnicities. I understood at that moment just how much alike we all are. In the end, we all enjoy to eat, drink, and be merry!!

Talent Show

Wednesday, January 30th, I attended a talent show put on by the kids/adolescents at Larue Carter Hospital. It was touching and saddening to watch. I appreciated the effort they put forth, identified their courageous attitude for participating, and felt sad because I knew that many of these individuals would grow up to face very difficult lives.

I was amazed at the courage these children showed. They participated in something that most people wouldn't dream of doing. They went out of their comfort zones and sang and danced in front of a large audience. I was proud and hopeful to see what resiliance and dedication these kids had. However, with the good always comes the bad. I realized, watching these kids perform, that many of them would go through life with many problems and would probably suffer due to their mental illness. It was sad to recognize this; I realized at that moment just how little we know about mental disorders. I hope that in their lifetime their will be better, more effective treatments to help them cope in society. Only time will tell.

It was a great experience that brought out positive and negative emotion in me. I was happy to see their strength and dedication but sad to know that many of their lives would be difficult. However, I realize that life is what we make of it and believe that each person truly has the opportunity to be happy; at least that is what keeps me going. The idea that we can all find a place where we can be happy and free is my dream.

Week 5 - LEAD Day

This week was a bit different than the previous weeks. I spent one day at LEAD and half the other day at the BSWSA Board meeting. As a result, I only spent four hours at my practicum site.

Activities -

• Attended LEAD Day
• Attended discrimination lecture
• Participated in march to the statehouse
• Completed scavanger hunt at statehouse
• Attended lunchion at IUSSW
• Attended BSWSA Board meeting
• Interviewed new client at Larue Carter and set the tone for a positive working relationship

Learning -

This week, I learned much. LEAD day was an eye-opening experience because it showed me what a diverse, dedicated group of social workers Indiana has. I also learned that social workers play many roles in many different areas of society. Moreover, I learned that social workers are proud of who they are and what they do. Lastly, I learned that it is important to be involved in what is happening around myself. Specialization is an important part of social work, but it is crucial that social workers are informed in as many aspects of social policy as possible. Afterall, if we don't know what's happening, who will?

Reflection -

I think I partially answered this question above but will further express my feelings. LEAD Day was an important experience for me as a social work student because I was able to see the cohesiveness and dedication that social workers around the state share. I was amazed at the amount of people that attended the event. I believe the most valuable aspect of LEAD Day for me was learning how important it is to get involved in public policy. Laws and bills affect us all, and the social work profession is especially affected by legislation. Lead Day was great but I feel that there could have been more "break-out" sessions offered for different interests. Overall though, it was a great experience.

Total Hours this Week (with LEAD Day): 14 hours
Total Hours to date: 81 hours

Pictures of LEAD Day (Statehouse)

Week 4

I have continued developing relationships with some of the patients and am acclimating myself to working with severe mental disorders. This was a busy week and I learned much.

Activities -

• Treatment team meeting
• Rounds meeting
• Attended care-provider meeting with three patients
• Continued working with patient from prior week
  
• Attempted to work on action plan
• Attended adolescent talent show and Larue Carter
• Refined learning plan and identified a few groups I would like to attend

Learning -

Larue Carter has several deaf patients that require interpreters so they can communicate effectively with the staff. My eyes were opened to just how dificult it must be for persons who are deaf and mentally ill. It is difficult for them to communicate how they feel and often feel isolated as there aren't enough interpreters. I have developed an interest in working with the deaf population and am seeking out deaf patients at Larue Carter to work with. I realize that they, just as all persons, deserve an appropriate amount of attention. I don't know where my career as a social worker will take me, but my interest in working with the deaf may alter or influence my course.

Reflection -

My personality affects how I work with clients and co-workers in multiple ways. First, I am a compassionate, empathic person and this influences how I treat the people I work with. When someone is upset or discouraged about their day or life in general, I am typically eager to lend an ear and give advice, if solicited. Also, my compassionate/empathic personality helps me to see people for whom they are on the inside and what their untapped potentials are. I believe that I generally care about people and this influences how I work with and help others.

Secondly, I tend to be an objective person and try to look at all possible perspectives of a situation. When helping people or working with coworkers, I am able to help them look past the obvious and see aspects that they didn't consider. I help by staying clam, taking critical looks at all angles, and staying focused on the issue at hand. I believe my ability to stay objective, even in personal matters, influences how I interact with all the different people I come into contact with.

Lastly, I believe my desire to succeed influences how I work with clients. There are many times in life when it seems easier to give up than to push forward. I believe I instill a sense of hope and possibility in my clients by my ability to express the possibilities I see. Often times, we learn from how others live their lives and not by what they say. My desire to succeed and move forward despite the obstacles brings a positive tone to the relationships I have with clients.

Total Hours this Week (with 2 seminar hours): 18 hrs, 50minutes
Total Hours to date: 66.5 hours

Week 3

This week has been really exciting as I have been more involved with the patients. As the weeks progress, I will be even more instrumental in helping the patients cope with life at Carter Hospital

Activities -

• Treatment team meeting
• Rounds meeting
• Worked on learning plan
• Identified possible groups and activities
• Met with first patient
• Attended discharge meeting with patient and supervisor
• Researched mental disorders in hospital library
• Reviewed charts of possible patients to follow

Learning -

As the weeks progress, I am learning more about how the state policies affect the population of Carter Hospital. For example, because the state doesn't want to pay nurses their average rate, it hires a registry to provide nursing staff to all the state hospitals. Unfortunately, there is no consistency, as there are different nurses everyday. As a result, medical mistakes are often made and patients don't get the quality care they deserve. For example, on one shift alone, there were 40 medicine errors made. Patients didn't get their meds, patients got the wrong meds, and some got too much of a med. I believe that these are unacceptable errors that are a result of a state system neglecting its responsibility to its mentally ill citizens.


Something else I learned is that working with such a population, one has to be "thick skinned". One patient I worked with this week cursed a lot and used derogatory language. I had to face my own prejudices and assumptions to look past what he/she was saying. I realize how important it will be to understand that sometimes patients/clients will make me uncomfortable, and it is something I have to get used to.

Reflection -

policy/macro

House Joint Resolution No. 8, Definition of Marriage. Provides that marriage in Indiana consists only of the union of one man and one woman. Provides that Indiana law may not be construed to require that marital status or the legal incidents of marriage be conferred upon unmarried couples or groups (www.in.gov/legislative/bills/2008/RES/HJ0008.1.html).

This bill is important to me because I am a homosexual male and feel it would be a blow to my rights. I am strongly in favor of homosexual marriage and feel this bill, if passed, would further separate homosexuals from society. I believe the government should set the standard and feel it will add to the further structural discrimination of gays and lesbians.

Senate Bill No. 310, Death Penalty and Mental Illness. Establishes a procedure to determine whether a defendant charged with murder is an individual with a severe mental illness. Prohibits the imposition of the death penalty on a defendant found to be an individual with a severe mental illness (www.in.gov/legislative/bills/2008/IN/IN0310.1.html).

Personally, I am not an advocate for the death penalty. However, this bill would, at minimum, keep persons with mental illnesses from being placed to death for a crime they may have committed. This bill is interesting to me professionally because I want to work in the mental heath field and will be a strong advocate for mentally ill persons. This bill would protect mentally ill patients from being sentenced to death for a capital crime, and thus they would be able to be treated for their disease.

Both of these bills are significant on multiple levels. Resolution No. 8 is significant to me personally because I am homosexual and therefore feel strongly in favor of homosexual rights, and Bill No. 310 is significant to me because I am personally invested in helping the mentally ill. I believe what ever agency I work in, it would definitely be effected by these two bills. Any homosexual client would be effected (especially at the Damian Center) by Resolution No.8, and a state hospital like Carter would definitely be effected by Bill No. 310 if the mentally ill were to be exempt from the death penalty. It is obvious how clients would be effected by the bills. Homosexual clients would be further discriminated against and mentally ill clients could possibly become exempt from being put to death (if they have committed a capital crime and been found guilty).

Total Hours this Week: 16 hrs 20 mins

Total Hours to Date: 48 hrs 10 mins

Week 2

Well, I have two weeks under my belt and feel really good about how things are going. I still haven't had much direct contact with the patients (as the social workers at Carter don't do a lot of one on one) but am planning on following a couple of the patient cases.

Activities -

1) Filled out Medicare application
2) Participated in discharge planning meeting with client
3) Attended a meeting with behavioral/mental health providers for three of our deaf patients that will be moving into a home together.

Other than that, I continued to orient to the hospital and get accustomed to the policies/procedures. I enjoyed my week and hope I will get more "hands on" experience as the the weeks progress.

Learning -

I decided to add this section as I wish to reflect on what I have learned thus far. I find in amazing just how complex and complicated the state FSSA system is. There is such a large chain of command and the bureaucratic nonsense that employees have to deal with really takes away from patient care. I find that the more the state cuts funding and rearranges the way the FSSA is managed, the more hospitals, such as Carter, are shoved to the side and ignored.

I also learned that social workers have many different tasks, and depending on the setting, wear different "hats" at different times. Social workers at Carter mainly do case management and are less focused on direct work with patients. Even the social workers who have an LCSW do little if any psychotherapy. I realize, by my experience at Carter, that the type of social work I perform will be greatly influenced by the agency/setting that I work in.

These items stick out in my mind as the main lessons learned thus far. It is quite exciting to reflect on the lessons I am learning just by observing the daily happenings of the hospital. I can start to see the light at the end of the tunnel, and am closer to understanding the role I will play in the social work field :)

Reflection -

Research/micro

As I am interacting more with the patients, I realize that there is a lot to be learned about how to interact with persons with a large range of mental illnesses. No one method will work for each person, and I believe that doing a research project on how to effectively deliver social services to persons with mental disorders/handicaps would be beneficial. It isn't the same as working with someone who has an average intellect. Most of the patients at Carter don't process information in the same manner as most people do, and I would be better prepared to work with this population if I learn techniques and strategies on how to communicate and interact more efficiently. More effective and correct communication between the patients and I will lead to better social work.

Total Hours this Week (with 2 seminar hours): 16 hrs, 20 minutes
Total Hours to date: 31 hours, 50 minutes

Week 1

Enlightening -

Going into this practicum, I really didn't know what to expect. I knew Larue Carter would be a challenging and interesting experience (being a state psychiatric hospital) and I wanted that thrill and unique experience that I knew it would offer. However, I hadn't a clue as to what I would be doing or what a social worker's responsibility was at Carter. This week has enlightened me to just how important social workers are to the population at Carter. After my first week, I can say that I am excited and glad that I have the experience to spend the next four months at Carter.

Activities - 

This week, I didn't have much of an opportunity to work directly with the population. I mostly spent time exploring the physical areas of the hospital, discussing social work tasks with my field instructor, and generally orienting to the practicum. However, I did participate in my first patient treatment team meeting and also observed some of the challenges that social workers and staff members face at Carter.

It was interesting being part of a treatment team meeting. We interviewed five patients and discussed their progress thus far. Team members included a psychiatrist, psychologist, social worker, charge nurse, division director, med student, and myself. The goal of the meeting was to give the patient an opportunity to ask any questions related to his/her treatment plan. It was exciting to see first hand how the treatment of patients is handled.

I also got to witness, first hand, the challenges that staff members face in a psychiatric hospital. During our treatment meeting, a code green was issued because a patient was out of control and had to be detained. I witnessed staff members detain the gentleman, the nurse administer medication to calm him, and then waited with the rest of the staff while the patient calmed down. I realized that it can be challenging for social workers and staff members to deal rationally with persons who are severely mentally ill. One has to have a certain level of compassion and understanding when dealing with a population as such. It was eye opening and exciting at the same time.

I absolutely loved my first week at Carter. I am excited to continue with my experience and can't wait to see what else I learn from this wonderful and unique population.

Reflection - 

Policy/Macro

Being a state hospital, there are many policies that affect patients on a regular basis. I am just learning about the policies of the hospital and how they affect patients. One issue that I did note was the lack of funding that has a direct effect on the population. As the state budget is being cut, Carter hospital is operating at the bare minimum, often without adequate physical surroundings for patients. The building is old and is in need of repair. But because finances are limited, little is left over to improve the environment. I believe that if more was done to improve the environment that most of these patients spend 24 hours confined in, it could have a positive affect on the patients' mental state. There seems to be a sense that the state is trying to unload this hospital and I worry what will eventually happen to the patient's that require the security and services it provides them.

Total Hours this Week: 15.5

Total Hours to Date: 15.5