CHCMH405A Work collaboratively to support the recovery process
Case study: Joe + Naomi
Slide 1
Welcome to the case study for the unit Work collaboratively to support the recovery process. This case study features Joe, a mental health support worker at a community mental health service, and Naomi, a client who has a dual diagnosis of mental health and AOD issues.
Select the arrow or play button to continue.
Slide 2
Naomi’s needs
Naomi has recently been referred to Joe’s service for support managing her mental illness and dealing with her drinking. Joe conducted a comprehensive assessment and is now ready to develop a case plan, together with Naomi. She has a number of issues to be addressed, including housing, her drinking problem, finances and employment.
Slide 3
Addressing Naomi’s issues
When Joe develops a case plan with a client, he focuses on one issue at a time. He draws up a table with four headings: Goals, Strategies, Review and Outcome.
For each issue, he discusses with the client their goals as well as strategies for achieving these goals. The person or people who are responsible for achieving the strategies are also identified.
Then, he looks at the timeframe for reviewing whether the goals have been achieved. This means also clarifying what exactly will need to be reviewed.
Slide 4
Task 1: Case plan – housing
One of the issues that Naomi’s case plan needs to focus on is obtaining more secure housing.
For this issue, develop the goal (or goals), strategies and review requirements.
(Note: The outcome column is not relevant for this task – you would fill it out, though, in a real-life situation.)
Issue / Goals / Strategies (and who’s responsible?) / Review / OutcomeSlide 5
Task 2: Case plan – drinking
The next issue is about changing Naomi’s drinking habits, with the view to stopping the drinking altogether.
Fill out the details on the case plan for this issue.
Issue / Goals / Strategies (and who’s responsible?) / Review / OutcomeSlide 6
Task 3: Case plan – finances
Naomi currently spends half of her social security allowance on alcohol. She has trouble budgeting and often cannot meet her financial commitments, which include money for rent, food and transport.
Fill out the details on the case plan for Naomi’s finances.
Issue / Goals / Strategies (and who’s responsible?) / Review / OutcomeSlide 7
Task 4: Case plan – employment
Naomi is currently receiving unemployment benefits. She would like to get a part-time job, although she’s not sure what she can do.
Fill out the details on the case plan for finding a part-time job for Naomi.
Issue / Goals / Strategies (and who’s responsible?) / Review / OutcomeSlide 8
Barriers to implementation of the case plan
Joe says, ‘It was easy to engage with Naomi and she was fairly straight-forward in what she wanted to change in her life. The difficult part came with supporting Naomi to actually followthrough on the plans we made. She found it difficult to stay focused, and I guess she was a bit frightened of the changes, particularly trying to give up alcohol’.
Joe says he couldn’t forceNaomito follow through on her plans but had to continually address the issues that arose and support her to move forward.
Slide9
Task 5: Supporting clients to stay focussed
- In what ways could you support Naomi to stay focused and committed to the case plan?
- Role-play with a partner, where you take the part of the case worker. Get your partner to play the part of Naomi. Naomi needs to communicate uncertainty about her goals and whether she wants to give up alcohol. You need to discuss her lack of motivation and commitment to the case plan.
Slide 10
Limitations
Through his work with Naomi, Joe realises he doesn’t have the specific knowledge or skills to effectively support her.
He says, ‘I’ve spoken to my manager about feeling under-skilled. We examined why I might feel this way, and, more specifically, what it was that Naomi needed that I felt I couldn’t give her. We talked about how well I had engaged with her and what it might do to her confidence if she stopped working with me and was referred to someone else.’
Slide 11
Task 6: Supporting clients
Read the details of your task on the screen.
What strategies do you think Joe and his manager could use to ensure that Joe feels confident in the support he is providing Naomi – and that Naomi is getting the support she needs?
FEEDBACK
Task 1 feedback
Case plan - housing
The issue is:
Naomi currently rents in the private market. She has been evicted twice before for not paying rent. She is currently behind in her rent as she spends her money on alcohol.
The goal is:
To have more stable housing in Naomi’s current housing or to move to public/supported housing.
The strategies are for the case worker to:
1) Refer Naomi to the Office of Housing for assessment – so Naomi can go on the waiting list for public housing
2) Refer Naomi to a supported housing agency for long-term supported accommodation
3) Refer Naomi to a financial counsellor/service to assist her to better manage her budget
4) Help Naomi find ways to address her drinking habits.
The strategies for Naomi are to make sure she follows up with the referrals and that she addresses her drinking problem.
The review date is usually in line with the strategy. With regard to making a referral, the review date might be four weeks. With regard to actually accessing housing, you might review this goal every three months.
Issue / Goal / Strategy (and who’s responsible?) / Review / OutcomeHas been evicted – afraid of another eviction / To have more stable housing in Patricia’s current home or to move to public/supported housing / •Referrals to:
-Office of Housing
-Supported housing agency
-Financial counsellor
•Address drinking habit / •Review of referrals: in 4 weeks
•Review of accessing housing: every three months
Task 2 feedback
Case plan - drinking habits
The issue is:
Naomi currently drinks 5-6 longneck bottles of full strength beer a day.
The goal is:
To reduce her drinking to a manageable level (as defined by Naomi) with a view to stopping drinking altogether.
The strategies for you, as the case worker, are to:
•Give Naomi information on the damage her alcohol consumption is doing to her health
•Discuss, with Naomi, her options for managing her alcohol consumption
•Refer Naomi to an alcohol detoxification program
•Refer Naomi to her GP for a health assessment and to assist with her detoxification support.
The strategies for Naomi are to:
•Make sure she is aware of health dangers and options
•Follow up with referrals.
As for the review requirements:
You might want to review, on a weekly basis, Naomi’s understanding of the health information you had given her, to ensure that she not only understands the information but is well-informed of her choices. The referral for a detoxification program may need reviewing, depending on the ability of the agency to take Naomi).
Issue / Goal / Strategy (and who’s responsible?) / Review / OutcomeDrinks 5-6 longneck bottles of full-strength beer a day / •Reduce drinking level
Stop drinking / Joe to:
•provide information
•discuss options
•make referrals.
Patricia to:
•make sure she’s informed
•Follow up with referrals. / •Weekly review to check Patricia’s understanding
•May need to review detox program
Task 3 feedback
Case plan – finances
The issue is that Naomi spends a lot of her money on alcohol and has trouble budgeting.
The goal is for Naomi to develop a budget and independently manage her money.
The strategies are for the case worker to refer Naomi to:
•a financial counsellor for budgeting assistance and advice
•supported housing to assist with daily living skills, such as budgeting.
Issue / Goal / Strategy (and who’s responsible?) / Review / Outcome•Spends half of allowance on alcohol
•Has trouble managing her budget / •Develop a budget
•Patricia to independently manage her money / Case worker to make referrals to:
•financial counsellor
•supported housing
Patricia to:
•Regularly review expenses
•Reduce drinking
•Follow up on referrals. / •Weekly review of expenses
•Review other strategies after four weeks
Task 4 feedback
Case plan – employment
The issue is that Naomi, who is currently receiving unemployment benefits, would like to get some part-time employment. However, she is not sure what she would like to do for work.
The goals are to:
•Get a part-time job
•Undertake training to gain employment.
The strategies are:
•The case worker to refer Naomi to an employment agency, to access employment with appropriate support.
•Naomi to take a look at TAFE and other training courses and, with the case worker’s help, Naomi needs to determine the type of employment she might like to train for.
Issue / Goal / Strategy (and who’s responsible?) / Review / Outcome•Would like to find a part-time job
•Not sure what kind of work she’d like to do / •Part-time job
•Training / •Case worker to make referral
•Patricia to have a look at courses
•Patricia, with case worker, to decide on type of work / Referral: review in 4 weeks
Training courses: Weekly review
Task 5 feedback
Supporting clients to stay focussed
If Naomi, or any other client, is finding it difficult to stay focused on the case plan you will need to talk to them about why they are feeling this way. It may be that Naomi’s fears are preventing her from achieving these goals at this time, or there may be other concerns in her life which are taking the focus of these goals. The case plan may need to be rewritten so the goals are smaller and more easily achieved. The purpose of the case plan and your support is to assist Naomi to make changes in her life and achieve her goals. It does not help her or your relationship with her if she is unable to do this. In fact, this may cause Naomi to become disengaged with your support and give up on the goals altogether due to a sense of failure.
Task 6 feedback
Seeking assistance
If three months has passed and Naomi is still having difficulty maintaining focus on her goals, it may be worthwhile for you to discuss the matter with your supervisor and get some outside assistance to work with Naomi. Your supervisor may have ideas and options that you haven’t thought of and can assist you to try different methods of engaging Naomi with her goals.
Case study transcript1