WEEK SIXTEEN

I'M DONE! :)

REFLECTION:

I've learned so much from this experience. I came into this semester thinking I would be working with children and adults with mental disorders such as downs syndrome, autism, etc. What I actually jumped into working with was so much different than anything I ever could have imagined. Never before had I ever (knowingly) had the opportunity to sit down and talk with someone suffering from mental illnesses such as schizophrenia, mania, or borderline personality disorder. In my past experience working with mental illness, I provided care for children with disabilities in their parents' homes. Working with families in the context of inpatient treatment was much different in that the parents were only aloud visitation during certain hours. At times, I found a lot of my counseling to be not only for the patients I was assigned, but their families as well. Overall, I really enjoyed this placement. I couldn't have asked for a better instructor (Thank you, Floy Hodson!), and will probably never top some of the situations I encountered at Larue.

Week Fifteen

ACTIVITIES:

• Terminate Services w/ Clients
• End of Semester Wrap Up

REFLECTION:

As I finished my final hours at Larue Carter, it was important for me to end my professional relationships with my clients there. I made sure everyone knew from the start that I would only be around until the 3rd or 4th week of April- so many were expecting my leave. However, on my last week, I walked around the unit, and said my goodbyes.

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

Sadly, I'm unsure of just how happy many of my endings have been at Larue. This has been such a difficult population to work with, as many of the patients are terminally ill, and many doctors have deemed these patients "untreatable." However, as a social worker, I will FIND success. I feel that this is one thing I do now to help clients experience successful endings. I feel that with one of my patients, simply attending group and/or talking in front of peers now is a huge success. Finding the triumph in little things can go along way. Especially when working with such an affected population.

WEEKLY HOURS: 28
HOURS TO DATE: 254.5

Week Fourteen

ACTIVITIES:

• Process Recording
• Routine Weekly Tasks

REFLECTION:

This week, I completed my process recording with Patient V. A little background on her- she is a 43 year old white female. She has been admitted to several hospitals (for both physical and psychiatric health related issues). During one of her last stays at a psych hospital she set herself on fire, and has been recovering from this incident (physically and mentally) ever since.

I thought our process recording was off to an OK start. However, I felt as though she was "toying" with me by doing her best to stay off topic (any other time, she is very attentive, and on task). I could sense that she did not want to talk about her serious issues- and that was fine with me. I know, as a social worker, that everything we talk about is completely up to the client.

Once I actually sat down and did the dictating/transcribing I was shocked to see how much I really have to work on my interviewing skills. I felt that I had too many "ums" and "uhs" in there. I also asked too many closed-questions. Though I have some work to do, I'm not too disappointed. It's a learning process, and I'm only beginning. I'll get the hang of it... soon, hopefully!

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

I would say one of the best ways to track progress/practice with patients would be to watch their progress in moving through their individual action plans. However, a more concrete way of evaluating might come from questionnaires or surveys.

WEEKLY HOURS: 21.5
HOURS TO DATE: 226.5

Week Thirteen

March 30th, 2008 - April 4th, 2008

ACTIVITIES:

• Follow up on recieving medical records on patient K
• Discuss with Floy the ethical issues present at Larue Carter

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

I have skipped my "reflection" section this week, due to the detail in which I would like to answer this week's integration question. It is almost too difficult to only pick one ethical dilemma I have experienced in the field. It seems that I am noticing them more and more as time goes on. Some are dealt with appropriately, and others are just tossed around until someone forgets about them.

First, I noticed with one patient in particular, the way he was being treated for mental illness could, in some eyes, be viewed as an ethical issue. The boy is actually 22, making him a young adult. He has no legal guardian, and therefore, should be "the boss" when it comes to decisions about his treatment- or one would think, if he were being treated at any other hospital. However, there are a lot of grey areas when working with mental health. This boy was showing signs of severe depression, paranoia, borderline personality disorder, and has some schizo-typical tendancies... However, I argue, that he should STILL be in control of his care.

He has been hospitalized (at Larue) for over 2 years. Before Larue Carter, he was in and out of various other mental health centers, since around the age of 13. Doctors and treatment teams have had quite a difficult time looking for the roots of his problems, and successfully treating him. It is a very difficult case to follow.

One day, this patient asked me to recieve medical records for him from his previous medical providers (please keep in mind that this is a high functioning 22 year old). His mother confirmed the names and addresses he had given me. I took two different consent forms (one for each mental health center) to the unit for him to sign. He signs the legal consent forms saying he would like information to be passed from "Mental Health Center A" to Larue Carter, saying he would like to have a copy of whatever I can find. He thought it might help fill in gaps in his memory as to why he's been in the hospital for so long. He also wanted a copy to go to his doctor at Larue Carter.

As soon as the fax arrived from "Mental Health Center A" I took a copy to the doctor. I explained to the doctor that Kyle would like to have a copy, and the doctor said, "No! No! NO!" I was shocked. His quick and stern reply made me feel pretty stupid. He explained to me that due to confidentiality, this information was coming from one doctor at "Mental Health Center A" to one doctor (him) at Larue Carter. Absolutely no one else was to see what I had been faxed. However, what I recieved were merely progress notes, MUCH like the ones we already had in his chart (available to nursing staff, social workers, and other team members) from his other previous hospitals.

I find my ethical dilemma here. The patient is an adult. He signed the consent form for information to come to the hospital (not just the doctor). If he asks to see it- why would he not be allowed to see his own chart? Afterall, it is information about HIM. That just kind of confuses me. I am researching this now, and would like to see what the NASW code of ethics has to say about it...

What do you think?

Please feel free to comment with any ideas....

WEEKLY HOURS: 21.5
HOURS TO DATE: 205

Week Twelve

March 23rd, 2008 - March 29th, 2008

ACTIVITES:

• Contact three previous mental health centers for medical records on patient K
• Set up a home visit for patient W
• Attend morning report
• Attend treatment team meeting

REFLECTION:

This week at Larue, I have been really busy! I was approached by patient K early this week with a request I had not yet encountered on my practicum. He wants me to contact his past medical teams to try to get information for him and his doctor at Larue Carter. First, there were consent forms to fill out, then I had to contact his mother to get the names and addresses of these centers. Next, I had to fax the mental health centers, and finally, wait on the medical records to be released to Larue Carter. It was nice to hand the records to the doctor, and see how happy he was to get the information. Some of the information I found will be used next week in a big conference (people from IUPUI, Eli Lilly, Larue Carter, and various other mental health professionals will be there to discuss) about this patient.

I also talked with the treatment team, had the doctor write an order, and spoke with patient W about a weekend home visit. He had worked very hard to work "up the levels" to be eligible for this pass, so he was very excited to hear the good news. Floy asked me to call his sister and set up times. It was so nice to be able to pass on some good news to a patient who otherwise seems so depressed. It was the first time I'd seen him look happy since I'd known him.

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

I've always thought the best way to find the answer to something you don't know is just to ask! But in a community, if you don't know who to ask, I would say the best way to determine what the formal and informal boundaries are in a community are to observe (or "watch and learn").

Weekly Hours: 25

Hours To Date: 183.5

Week Eleven

March 16th, 2008 - March 22nd, 2008

ACTIVITIES:

• Take Quiz #1
• Attend daily report/take notes
• Attend weekly treatment team meeting
• Help facilitate Cognitive Distortions Group
• Help facilitate Art Therapy Group
• Help pass out/fill out medicaid papers

REFLECTION:

This week was also very similar to previous weeks. I had to take my quiz (on which was pretty upset with my score- I hate true/false questions!). At the agency though, things are running pretty smoothly. No major problems or concerns... No big exciting news... just another week at the hospital. I am preparing to complete my process recording, and looking foward to that- should be pretty interesting.

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?

This is a pretty easy question for me, because I have been noticing differences like these since day one. When the interdisciplinary team (of doctors, nurses, dieticians, chaplains, social workers, psychologists, etc.) all get together, it seems that each of us are monitoring different aspects of the clients hospitalization. Doctors want to know about the medications (compliance, dosage, side effects, etc). Nurses want to know about vitals and daily health (so that they can report to the doctor, if medication or other orders are needed). Dieticians, of course, are worried about nutrition, while chaplains are more concerned with the spiritual needs of the patient. As social workers, I feel like we act sometimes as the "glue". We don't need to know the medication dosages, but we do need to observe/be familiar with the clients behavior (speech, actions, etc) after taking such medications. We may not need to know the vitals of each patient, but if someone is unhealthy physically, they will not be feeling their best mentally. Food and spirituality also play a huge role in how a person feels. Our job is to advocate (or voice) the concerns of the patient, and do whatever we can to help them on their journey through recovery.

In assessing a patient, we may want to know typical demographics, such as, addresses, phone numbers, contacts, etc. We might also ask for any family history of physical or psychiatric illnesses or treatments. Nurses may need this info as well, but what we do with this information is completely different. Nurses need to know blood pressures, heart rates, temperatures, etc. These are equally important in keeping the person alive and well. I find it interesting the ways in which our team interact, share information, and overall work together to help the patient in evrey way we know how. :)

WEEKLY HOURS: 28.5
HOURS TO DATE: 158.5

Spring Break

March 9th, 2008 - March 15, 2008

Spring Break

Weekly Hours: 1
Hours to Date: 130

Week Nine

March 2nd, 2008 - March 9th, 2008

ACTIVITIES:

• Help Floy plan for art therapy group
• Take notes for Floy

REFLECTION:

Floy is out this week, and has asked me to take her place in the morning report with treatment team, as well as hang around the unit and answer any patients' requests. I also attended groups with Michael Kura and other Larue Carter staff. Overall a good week.

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?

There are no set time frames for any patient at Larue Carter. Working in mental health, it could be very stressful to try to put deadlines on treatment plans. We do have a set day for treatment plans: Tuesday mornings. Each newly admitted patient is seen in treatment team every other week. After they've been there for awhile, and are stabilizing, they are seen once each month. After that, they may be seen once every other month. However, each treatment plan is completely individualized and timing is completely determined by each individual patient.

Weekly Hours: 22
Hours To Date: 129

BOOK REVIEW

BOOK REVIEW

As I was searching socialworktalent.net for a practicum placement last semester, I read through some of the requirements of other placements for mental health. I think it was a placement at Midtown Mental Health Clinic under the supervision of Dr. Moody which required students to read this book. I did not choose the practicum placement with Dr. Moody, but knowing I would be working with severely mentally ill patients, thought this book would be a great help in understanding the mind of a schizophrenic. My prediction was very accurate.

This book, The Quiet Room, re-tells the true story of Lori Schiller and her own encounters with schizophrenia. I highly recommend this book for anyone interested in the field of mental health, or anyone who has directly or indirectly been affected in some way by schizophrenia.

I did not write the following paragraph, rather copied it from the back of the book. I thought it sums up the story beautifully. The back of the book reads, "At seventeen Lori Schiller was the perfect child--the only daughter of an affluent, close-knit family. Six years later she made her first suicide attempt, then wandered the streets of New York City dressed in ragged clothes, tormenting voices crying out in her mind. Lori Schiller had entered the horrifying world of full-blown schizophrenia. She began an ordeal of hospitalizations, halfway houses, relapses, more suicide attempts, and constant, withering despair. But against all odds, she survived. Now in this personal account, she tells how she did it, taking us not only into her own shattered world, but drawing on the words of the doctors who treated her and family members who suffered with her. Moving, harrowing, and ultimately uplifting, THE QUIET ROOM is a classic testimony to the ravages of mental illness and the power of perseverance and courage."

Spending long hours within the cement walls of Larue Carter Memorial Hospital, I found it almost eery the parallels between "Lori's world" and the world of Larue's patients. The way she talked, the way she thought, the medicines she was taking, the lingo and procedures of the nursing staff... all the same. I enjoyed reading the testimonies from Lori's family. I get to see some of the patients' families about once a month, but never get to spend too much time really talking with them, and understanding where they are in their minds. This book painted a much clearer picture of that for me.

Week Eight

"Cognitive Theories..."

February 24th, 2008 - March 1st, 2008

ACTIVITIES:

• Think up ideas for Art Therapy group for Floy
• Attend Cognitive Disorder group w/ Michael Kura
• Print out sign in sheets for treatment team planning meeting and turn them into Deb Skinner
• Turn in Midterm Evaluation

REFLECTION:

Floy is out this week, taking care of her daughter who is having multiple medical procedures done. I pray that everything turns out OK for her and her family. In the meantime, I am continuing to attend groups with the patients from our unit, getting to know them better, and taking notes of things happening on the unit for when Floy returns. I am also getting the opportunity to follow different social workers in the hospital, and get a feel for different units and their patients. This Thursday, I am going around with Michael Kura to do psych testing on newly admitted patients. I am very intrigued by all of this, and expect to blog all about it later this week!

INTEGRATION QUESTION:

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

I find this to be a very interesting question, working in a psychiatric hospital. Each patient is so unique, and may require different theories to be treated most effectively. In group with Michael Kura, we focus mainly on cognitive theories. That is, how we think, what we think, and when and why we think what we think (you think you got all that?). I believe in the field of mental health, these questions are very common among patients. In order to correct their thinking patterns, they need to be more in tune with them, and understand them better.

Weekly Hours: 21.5
Hours to Date: 107

Week Seven

"Traits of a Social Worker..."

February 17th, 2008 - February 23rd, 2008

ACTIVITIES:

• Attend group on Cognitive Distortions with Michael Kura
• Attend meeting with mental health clinic liason and patient V
• Admit patient C

REFLECTION:

Last week, I was almost shocked by our newly admitted patient V. I'm getting to know her a little bit better now, and am putting my generalist social work practices into play. I warm up to here by creating small talk, and egaging her. I let her share as much or as little as she would like, and I actively listen to what is on her mind. When she has questions, comments, or concerns for the nurses or for Dr. Perez, I let him know. I had the opportunity of sitting in on a liasion meeting with patient V and her liason from Midtown Mental Health Clinic. I knew right away that patient V recognized, respected, and valued her relationship with her liason (or case manager). Basically, the liason's job was to check up on V to make sure she had been admitted OK, the transition was moving smoothly, and she understood why she was there, and what her goals were this time around. It was all very interesting, but sad at the same time. Tears were shed, and plans were made. The entire meeting lasted about 30 minutes, then it was time to go. I appreciated seeing V's liason focusing on her strengths. It helped me also focus on her existing strengths and actively search for new strengths I might be able to point out to her.

After attending the liason meeting, another new admit had arrived. Again, Floy and I attended the treatment team meeting to hear his story, where he came from, how he ended up here. Then we went back to her office to complete a psychosocial history over the phone with the patients mother. She was so nice! Her voice was comforting, she had such a positive attitude, and you could tell by talking with her how much she truely loved and supported her ill son. Toward the end of the conversation, we began asking her about her own life. Yep. She's a social worker... pretty cool, huh?

INTEGRATION QUESTION:

Research/micro: What has research shown to be the traits a social worker needs to have to engage with a client?

In my own experience, I would say there are many “pre-requisite” personality traits one must hold in order to be an effective social worker. Everything I have read about in previous class work supports my theories, and some recent internet research backs me up as well.

Social workers need to be patient... The people talking to social workers usually have a history of the problem they bring to the social worker. It took them a long time to “build” this problem they have now. It may have taken them a long time to decide to come see a social worker. Why would a social worker expect to solve the problem over time. It can take weeks, months, even years to find effective solutions to some problems. Some patients will move more quickly through treatment plans than others. Social workers must be patient people, always trying to move toward the goal, but never angry if it takes longer than planned.

Social workers should be empathetic… This is not to be confused with sympathetic. We, as social workers should not feel the need to feel sorry for our patients. Rather, we need to empathize, or put ourselves in their shoes, try to see things from their perspective. Patients should not want to be felt sorry for, they should want to be understood.

Social workers need to be open-minded… We do not choose our clients. And our clients don’t choose their problems. As social workers, we must remain open-minded and respectful toward all walks of life we may encounter on the job (color, creed, gender, age, orientation, etc.). When patients/clients have backgrounds different than our own, we must learn to accept and adapt to whatever that background may be.

References

Miley, K., O'Melia, M., & DuBois, B. (2007). Generalist Social Work Practice: An Empowering Approach. Boston: Pearson.

Web slides per Dr. Ouelette’s S332 Online Course


Weekly Hours: 20
Hours to Date: 85.5

Schizophrenia

sChiZophReNia

Growing up, I had never heard of anyone having this disease they call schizophrenia. In psychology class we breifly studied it. I began to understand the disease as, "total loss of reality." This definition was fine for the moment, but in hindsight, I kind of just shrugged my shoulders and understood schizophrenia as a politically correct way to call someone crazy.

When I signed up for this practicum, with mental health in mind, I thought I would be dealing with autism, downs syndrome, and other developmental disabilities (an area I am very comfortable with). When I got to the hospital and saw people who looked and seem to act just like me, I knew I was in for a huge learning opportunity. Many patients at Larue suffer from schizophrenia and schizo-affective disorder, and I needed to know a little something about it.

Dr. Michael Pisano, who has studied years of psychology at IUPUI, allowed me to sit in on educational groups he led for patients with schizophrenia. In group, patients were given folders, handouts, worksheets, and opportunities to ask Dr. Pisano anything they wanted about their disease. We discussed neurological, biological, and psychological factors of the disease, symptoms, as well as the pros and cons of different types of medications used to treat schizophrenia.

Dr. Pisano could not seem to emphasize more the importance of compliance with doctors medication orders when treating schizophrenia. One of my classmates mentioned the side effects associated with medicines used to treat patients with HIV. The list of common side effects for schizophrenia meds, sadly, is no walk in the park. Side effects range from:

• drowsiness/sleepier than usual/difficulty falling-staying asleep-early waking
• dry lips / dry throat /dehydration
• dry skin / rough texture / skin flakes, sores, bleeding skin cracks
• weight gain- increased appetite
• stomach aches / unusal pains in belly
• constipation / inability to urinate
• muscle agitation / less able to sit still or stand still / fidgeting
• sexual difficulties / impotence or decreased ability to achieve orgasm
• dizziness / feeling faint, lightheaded, loss of balance
• sensitivity to sunlight / skin may burn more easily
• blurred vision
• absence of female menstral cycle
• etc. etc. etc...

HOWEVER, these medicines can drastically improve one's quality of life. Have you ever read all the symptoms on the back of that asprin bottle you carry around in your purse? Do it sometime. You may be quite suprised. All medications have side effects. Sometimes you just have to take the good with the bad. And sometimes, you need to wait it out, talk to the doctors about changing the meds or the dose, or take additional medications to control the side effects. Always keeping in mind that the medication works best when taken exactly as prescribed.

Though no one really knows the exact cause of schizophrenia, it is highly correllated with too much and/or too little of certain brain chemicals. Medications change the amounts of these chemicals and work best for reducing delusions, hallucinations, and agitation. These medications are safe, effective, and non-addictive. They have been known to prevent and/or delay relapses and the need for rehospitalization.

Overall, these medications help patients with schizophrenia feel happier, brighter, and healthier.

Week Six

"I'm a social worker... not a miracle worker..."

February 10th, 2008 - February 16th, 2008

ACTIVITIES:

• Attend weekly treatment team meeting
• Attend Dr. Pisano's group on Schizophrenia
• Admit patient V

REFLECTION:

Well, it's about time for me to be "assigned" a patient (or two) now. Floy and I had discussed me taking charge of the next admission to the unit. That new patient came this Tuesday, and Floy and I agreed that maybe I should wait for a different patient. The patient admitted this week is a returning patient. She is a 43 year old white female who has been hospitalized over 40 times in her lifetime, all due to some kind of self harm/suicide attempt. Looking through her old charts I found a long list of diagnoses: bipolar disorder, borderline personality disorder, schizo-affective disorder, and anorexia nervosa were the main ones. She had an even longer list of medications, ranging from antidepressants, mood stabilizers, antipsychotics, lithium for the bipolar disorder, and many many more. Floy said she remembered patient V very vividly. Last time she had been admitted she had weighed 160 pounds, and was best known for cutting/scratching herself, and using anything she could find around the unit to keep the wound open or prevent it from healing. Since her last discharge, she had set herself on fire, twice, and her weight had dropped to a whopping 91.5 pounds. She looked like a skeleton with grafted and scarred skin stretched out over each of her frail little bones.

As a mere student, I really did not feel I would be the best "social worker" for patient V, and agreed to take the next admission instead. Wow. Things here at the psych hospital are really starting to open my eyes. I had no idea I would be working with such visably mentally ill patients. This was shocking to me. I questioned myself on how badly I really wanted to work in mental health... Was there anything I could do to help this patient? If the 40 some hospital admissions did almost nothing for her, how could I be of any help!?!?

After pondering these thoughts for a few days, I began to regain hope. I sat down one day and talked with patient V. She was suprisingly casual with her words, and seemed to be very bright, and willing to talk. We even cracked a couple jokes. I have not lost hope for her (or for myself for that matter). Maybe I won't be able to "save the world" as a social worker... Maybe I can't "save" everyone from themselves... But I CAN talk to and listen to patients who need me. And sometimes, being locked away in a hospital unit, a good laugh can be the best medicine of all.

GROUP WORK:

I attended Dr. Pisano's group on schizophrenia this week. The information was very interesting. We talked about recognizing and coping with the symptoms of schizophrenia, the different medicines and their importance in living a functional life with schizophrenia, and also the neurological, biological, and hereditarial basis of the disease. Dr. Pisano seems very knowledgeable on this subject, and I was able to stay after to ask my own personal questions about the illness.

I think it is very important for anyone working and any field to have a deep understanding of the psyche of the patients, clients, consumers, (whatever you want to call them), that he or she serve. If I were the head chef of a fine restaurant, I would want to know exactly what foods tastes good with what sides, and what wine is best to serve with what meals. Same is true for people-professions. If I'm working with a client population affected by schizophrenia, I want to know what "meal" they are hungry for. Or, what is the goal of their stay here at the hospital. What "sides" or treatments do they need (what meds), and what kind of "wine" (therapy) would compliment that meal and side dish the best. Pardon the abstract anaolgy. I must be getting very hungry... I guess my point here is that I want to be knowledgeable of my clients status. If they are going through something I have never encountered before in my personal life, I want a crash course on the subject to prepare me to help them to the best of my ability.

INTEGRATION QUESTION:

There are no integration questions listed for week 6... Just reflections. :)

Weekly Hours: 21.5

Hours to Date: 65.5

Diversity Lunch

DIVERSITY LUNCH

I was lucky enough to be invited down to the annual Larue Carter Memorial Celebrates Diversity luncheon. Members of the staff were asked to bring in traditional dishes from their own heritage. I had never seen so many types of food on one table! I filled my plate with worldly goodness and sat down to eat a wonderful lunch with my co-people.

I would have liked to have an awesome blog about this luncheon, but after reading David Kearby's practica blog (we are practicing at the same agency), I've got nothing! I think he summed it up perfectly by stating that other than a wide variety of platters to choose from, diversity ceased to be the topic of discussion at most tables. Which in my opinion (and sounds like David's too), is a wonderful thing. Diversity should be expected and celebrated year round! I think everyone had a great time just socializing as equals and sharing the amazing food.

Week Five (LEAD)

"Two! Four! Six! Eight!

Social Workers Advocate!"

February 3rd, 2008 - February 9th, 2008

ACTIVITIES:

• Participate in LEAD
• Write letter to legislature
• Attend Cognitive Distortion Group w/ Michael Kura
  

REFLECTION:

LEAD was pretty cool (I'll mention this more in the integration questions).

INTEGRATION QUESTION:

Policy/macro: What was your experience at LEAD? What was most valuable? How could your learning experience have been improved?

I had a great time at LEAD this year. Upon arrival at the hotel, we were directed to the basement, where LEAD was being held. We listened as speakers explained what social work meant to them, and why social work was such an important field. I went to LEAD last year, too. I thought this one was pretty repetitive, but equally as valuable. I learned a lot in the breakout session about discrimination and current bills being reviewed deal directly with discrimination issues.

I thought the most valuable information gained this time around was the scavenger hunt. Last year, I went and visited the statehouse, but never really found out where (or what) anything was. The scavenger hunt gave me a much wider perspective of what really goes on over there.

My learning experience could have been improved. I feel like next year, seating should be clearly marked so that schools can sit together. (David and I ended up in an entirely different section than our classmates...). I also think there should be MORE (or different) break out sessions added.

Overall, good day.

Weekly Hours: 15
Hours to Date: 44

Week Four

"15 Minute Checks for SI/SIB..."

January 27th, 2008 - February 2nd, 2008

ACTIVITIES:

• Perform Psychosocial Evaluation on newly admitted patient
• Ask questions
• Have January time sheet signed

REFLECTION:

I can't believe January is over! It's been a much quieter week after last Tuesday's treatment team planning meeting with patient K. I am getting to know my patients a little bit more each day. I'm also getting used to all the fast talking done by nurses and doctors. During report, the nurse gives the "pass status" of each patient. Each newly admitted patient will automatically be placed on unit restriction for approximately 2 weeks. After they complete 2 weeks of good behavior, they can earn their next level. Pass privileges may be taken away as a result of bad behavior. I asked Floy what all these terms and abbreviations meant.

One-to-One- This is the most restricting pass there is. These patients have nearly no privacy whatsoever. A staff person must be within arms length of this patient at all times (this includes restroom and shower privileges).

ICST- Incompetent to Stand Trial- This isn't really a pass. Rather, it is just an abbreviation I see after many patients' names during report. These patients usually have open criminal charges against them, but the court has agreed that they are not mentally healthy enough to stand trial. They are here, in the hospital, trying to get well enough to stand trial. Sometimes, time served in the hospital may count for time they would have spent in jail. Other times, this is not the case. Each case is court and judge specific.

15 Min. Checks (indication specified)- Patient is checked on every 15 minutes by staff for one or more of the following reasons:

• SI- Suicide Idealization
• SIB- Self Injurious Behavior
• Other indications for 15 minute checks include assault, escape, sexual precautions, etc.

UR- Unit Restricted- Every patient starts here. These patients may leave their room, to go to the med line or the lounge, but may not leave his or her unit.

ESC- Escort- These patients have permission to leave the unit to travel inside the hospital if and only if accompanied by staff personnel. One staff member may be in charge of escorting multiple patients to dining room, gym, chapel, etc.

B- Buildings- These patients have permission to come and go freely from their unit and around the hospital. This pass is highly respected and coveted among patients, due to the fact that this is the necessary pass one must have to go out to the smoking area for cigarettes. This pass also allows some patients to find hourly minimum wage jobs within the hospital.

B&G- Buildings & Grounds- This is the highest pass offered at Larue Carter. With this pass, patients may come and go off their unit, and in and out of the hospital. They may not leave hospital grounds, but are allowed to walk about outside, play volleyball, basketball, or other outside activities.

With spring just around the corner, it should be a goal of many patients to earn that B&G pass, so they can enjoy the great outdoors. However, earning passes is hard work, and takes much time and commitment. We'll see how it goes...

INTEGRATION QUESTIONS:

HBSE/micro: Where do you think personality develops in terms of someone’s physical and emotional growth?

Personality is developing as soon as, and as rapidly as, everything else in the human body is developing. In terms of physical and emotional growth, I believe personality is constantly growing and developing. I strongly believe that in (especially in the younger years), a person's personality is growing as a result of the environment they are in. I.e. If a person is raised in a nurturing, supportive environment, positive personality traits will be encouraged, and shine through in the individual in following stages of life. Just as a person growing up in a less than supportive, maybe abusive environment may show more negative personality traits. These negative personality traits can be due to many factors (abuse, neglect, etc). And if left untreated, can manifest into a wide array of personality disorders. However, this is just my opinion. I know there are cases out there to disprove my theory. In fact, I see it in my patients at Larue Carter. I believe the mind and body to be very interdependent. I.e. If a person feels physically healthy a person will be physically healthy.

Practice/micro: How does your personality reflect and influence how you work with clients and coworkers?

I think, especially in the field of social work, attitude is everything. I have received multiple compliments about my positive attitude at work and at my practicum, and I think it can make everyone's life a little easier, just to be in a better mood. Smiling, making eye contact, actively listening, and engaging clients when you see them about the unit (not only when you're looking specifically for them) will make you seem more approachable, and clients will feel more comfortable talking with you. Also, smiling is contagious. Work is not always easy. When doctors, nurses, and other staff are having a long and hard day of work, remaining upbeat and cheerful can more often than not, help relieve some stress. If you appear to be stressed, bogged down, too busy, or upset with outside things, (all together presenting a negative affect) those you are communicating may tend to view things you have to say more negatively, or else, speak what they have to say in a more negative manner. I have found this to be very true working in a state funded psychiatric hospital. Having a good (and professional) sense of humor helps take your mind of the days stresses sometimes, and helps everyone get along a little bit better.

Weekly Hours: 14
Hours to Date: 29

Week Three

"Now that's what I call team work..."

January 20th, 2008 – January 26th, 2008

REFLECTION:

Floy warned me that this week we would be a having a very interesting Treatment Team Planning Meeting. She could not have been more correct in her warning. Today I was introduced to a very famous patient on the unit. (For confidentiality purposes, I have renamed him K*) As I walked into the report room to take a seat for the meeting, I looked around at the plethora of support persons all interested in the treatment and care of patient K. Just take a look at this roster:

• Dr. Helio Perez, MD (an expert in medicines of mental health)
• Medical Student #1
• Medical Student #2
• Kursar, the dietician
• Susan, the chaplain
• Michael Kura, from the psychology department, but currently filling in for a social worker on extended medical leave
• Med Nurse, RN
• Floor Nurse, RN
• Galean, the drug/alcohol counselor
• Floy Hodson, LSW
• Me, Social Work “Student Intern” (ß that’s what it says on my badge!

And that’s just the staff! Patient K also had some family members attend this meeting:

• Mom
• Aunt (mother’s sister)
• Uncle (mother’s brother-in-law)
• Grandfather (mother’s fater)

All of these people came together to sit around one table and discuss what is and isn’t working for patient K. The meeting opened with Dr. Perez asking K to introduce/explain himself, why he’s here, and what he needs from the treatment team.

K opened by unfolding and reading a small crumbled piece of paper he had previously scribbled on. In this letter, K expressed tremendous concerns about the medicines he was taking. He was fearful of permanent psychiatric damage, and went into great detail explaining his concerns. Dr. Perez thanked him when he finished, and jokingly stated that he would “put it in the box” where he kept a stack of letters almost identical to the first one, all authored by K.

We spent almost 30 minutes listening to K express his immense anxiety, fears, worries, frustrations… things started to get very repetitive. His family would interrupt him, telling him that he just worried way to much, and the staff agreed. This was a 21 year old, white male, with a very loving and supportive family. A little part inside of me just wanted to yell, “Whoa, chill out!” to this boy I saw sitting across from me. But I know his problems are deeper than that. I maintained good eye contact, and listened very attentively to what he was saying. At times, I felt like I was listening harder than anyone in the room… and then I realized why. Patient K has been a patient at Larue Carter for nearly two years now. Floy tells me each Treatment Team Planning Update meeting has been around these same fears and worries of patient K…

Patient K sounded almost hopeless by the end of this interview, but he was reminded today of what an awesome strength he has... SUPPORT. Above, I listed 15 people who are actively looking for any way they can be of help. I thought support like this was amazing, and I let patient K know it. :)

INTEGRATION QUESTION:

Policy/macro: What Indiana Bills & Resolutions for the Spring 08 Legislative Session are of interest to you personally? What Indiana Bills & Resolutions are of interest to you professionally? Describe their significance to you, your agency, & your clients.

Personally, I take interest in bills pertaining to issues such as womens health, education, health care (for all persons), mental illness and the mentally impared. As a female student born and raised in a very "medical" family (many relatives work in the hospital setting), these topics are of particular interest to me, and I have cared about many of these issues for years now.

After researching bills and resolutions that may be of particular interest to my future career in social work, I would still need to stay current with bills regarding mental health care. If I were to find a position at Larue Carter, or any other state agency, I would be very interested in learning more about House Bill 1095, which discusses living wage contracts for state agencies, as this bill could directly affect my earnings and wages. A similar bill, Senate Bill 0350, discusses funding for mental health centers- I think this one would be equally important to me as well.

One bill I need to study up on, which will directly impact my practicum would be House Bill 1266, which explains eligibility for medicaid, and seeks to set up priorities for services provided. I think this is very important, as two cases we are currently handling could have been done weeks ago, had the medicaid eligibitiy been cleared sooner.

Weekly Hours: 13
Hours to Date: 15

Week Two

"I am starting to get the feel of things..."

January 14th, 2008 - January 16th, 2008

REFLECTION:

I am starting to get the feel of things around the hospital now, and am starting to understand what needs to be put into my learning plan, and how I can accomplish those things.

I understand that every morning we have “report” in the conference room. The purpose of report is so that doctors, nurses, and social workers can be updated on patient health and behavior each morning. The report is usually given by a nurse who has communicated with the night staff nurses. I was given a sheet of paper with each patients name on it, and told to “jot down important notes.” I am still pretty new at this, and everyone seems to talk so fast! The nurse reads off a patients’ name, tells their “pass status” (which is where in the hospital the patient is allowed to go… I still need to grasp understanding on this concept) then the nurse reads off their vitals, and mentions any behavioral problems the patient might have had in the last 24 hours. This gives the doctor a chance to write new orders in the chart, and any of the “treatment team” a chance to communicate ideas.

Tuesday mornings are special. Every Tuesday on our unit, after regular report, we have a TTPU, or Treatment Team Planning Update. This meeting is similar to report, however, the patient in focus, as well as any family member or support person, is invited to attend. I found this meeting to be very beneficial for everyone involved, and plan to report more on these TTPUs later...

INTEGRATION QUESTIONS:

Research/Micro: How could doing research for classes impact your relationship with your clients?

Research is so important, especially in the field of social work. Working with mental illness, I have learned to love researching. When I am introduced to new clients, I am respectively introduced to new diagnoses and other histories. Making myself knowledgeable with these concepts will not only help me work better with my clients, but it will also help me become a better teammate to my colleagues.

For example, during a practicum visit, my instructor was dealing with a difficult situation surrounding a clients Medicaid applications. I knew a little bit about welfare and the basics of Medicare/Medicaid, but found myself much more comfortable talking to her about this situation and asking questions after I came home and googled the different Medicaid options our client was exploring.

Another example of research being very beneficial in respect to clients and co-workers within the agency comes to mind. This patient has long been diagnosed with schizophrenia (among other illnesses). Each morning, a staff meeting is held with the social worker team, doctors, nurses, and any students to discuss (in an interdisciplinary fashion) the patients progress. Dr. P highly recommended that any med/nursing/social work intern interested attend the schizophrenia seminar being held by one of his colleagues, who is an expert on the subject. Having a better understanding of the diagnosis/illness helps the entire staff communicate better, and ultimately provide better care to the patient.

Policy/Macro: What is the agency policy about relationships at work? What are the consequences of infraction of the policy?

Although teamwork and professional relationships are highly encouraged among the Larue Carter staff, there are strict policies regarding inappropriate relationships between patient and staff. No staff member may engage in any relationship past the professional/acceptable relationship with a patient. This means, as staff, you may not date or have intimate relations with patients. It also means you may not accept money or gifts from a patient. Infractions are taken very seriously and consequences will be severe (i.e. immediate elimination).

Weekly Hours: 1
Hours to Date: 2

Week One

"What have I got myself into?!"

January 7th, 2008 – January 9th, 2008

ACTIVITIES:

• Meet Floy
• Meet other staff
• Orient myself to unit

REFLECTION:

Tuesday was my first day at Larue Carter Memorial Hospital. I parked out front, and walked through the main entrance promptly at 7:50AM. A security guard stopped me, asked for my name, and told me to wait in the waiting area for my field instructor, Floy Hodson. What an experience that was. I waited patiently, watching patients, patient’s families, and staff walking in and out of the building. I saw an older woman signing (sign language) to a younger deaf man in a wheelchair. I smiled at a few passers-by, and they smiled back. Then I nodded at another individual standing by the security window. He was rocking backing and forward and apparently did not like my smiling and head nodding in his direction. He moaned back at me. “I have had a little bit of experience in the mental health field,” I thought. But from day one, I knew I was in for a crazy ride…

INTEGRATION QUESTION:

After meeting your first client, can you tell what stage of development they are at, according to the theories you have learned in human behavior?

I haven’t really been “assigned” any patients just yet. I am working with Floy, just getting oriented to her unit, 3E- Adult Unit, and getting to know some of the patients there. But of the patients I have met, and had a chance to sit down and talk to, I still think this question is a little difficult to answer. Working with mental health, precise developmental stages may be ambiguous, due to the nature of the patient’s mental illness.

Because it is an adult unit, all patients here are over the age of 18. However, some are performing at the developmental stage you would typically associate with a 7 year old. For example, one patient, Jessica, is 18 years old, but insists on sucking her thumbs, carrying dolls, and throwing temper tantrums (actually, I hear temper tantrums are common with a lot of our patients).

I would say, due to the nature of their illnesses, many patients at Larue Carter are developmentally behind typical development of their peers. However, there could be many exceptions. I guess I’ll find out… in time.

Weekly Hours: 1
Hours to Date: 1