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