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