The second week of my internship I gain more responsibilities. One of those responsibilities is to complete client documentation. I chart the type of session, level of treatment, my assessment of how the client and service recommendations. I typically chart for between seventeen to twenty-five clients each day. My prior case management class taught how to use proper writing styles. At Northwest Indian College we practice writing correct chemical dependency chart notes. Documentation is legal document that reflects the client’s treatment process. DCFS, DOC, insurance companies and Drug Court may gain access to the documentation. It is important to document in a proper, ethical manner. Incorrect documentation may have serious consequences for the client and employee.
During my second week of internship I felt that another new intern made an incorrect assessment of a client and in doing so made a documentation error. The other intern judged the client to be resisting treatment, and not participating in services. The intern came to this conclusion by various, incorrect assumptions. The intern felt that the client was emotionally disengaged from the group. In reality this client may appear to emotionally “flat” due to continued detoxification stage and/or psychological disorder. Another justification from the other intern was that the client refused to read the group guidelines. The intern was unaware that the client is functional illiterate. The client also belongs to a racial group that culturally discourage public speaking. The other intern would have more correct view of the client if she would have asked staff more familiar of the client or read the client’s charts. Incorrect assumptions create an incorrect view of the client.
This intern had incorrect assumptions based from general lack of knowledge about the client. She also assumed that she had enough knowledge to make a sound assessment without asking for help. I learned from this experience not to be afraid to ask for help. I can easily recognize “flat” facial expression due to my past work in mental illness field. I later checked her file to see my suspicion to be true. I know about the client’s ability to read from previous discussions with the group leader. This intern was too confident on her abilities after limited contact with the clients (two sessions).
The curriculum in my first core class in Human Services program helped me to begin to explore my personal assumptions. An individual’s assumptions are based on their socio-economic status, personal experiences, values and cultural heritage. That intern’s assumption that everyone can read is an incorrect assumption. Her worldview limited her ability to recognize that not all people read well. In fact it added the intern to have a negative view of the client. The intern is from a community college and may not have been taught yet about her assumptions. The ways we look at clients greatly impact the quality of services. This intern may have learned when I pointed to this to her.
2nd Reflection Essay
There is a large emphasis at Pioneer Center North in the development of solid client discharge plans. Individuals who are gravely disabled by their addiction cannot remain sober without housing and on-going counseling. A typical discharge plan locates housing and outpatient chemical dependency treatment. The case managers locate specific inpatient treatment that will best work with the client specific needs. Most outpatient treatment can last between one and two years. Case managers receive feedback from the ID team on client’s exit plans. Some clients are referred to other inpatient treatment programs. Discharge plans and continual treatment recommendations cannot exist in a bubble. This last two weeks I become more painfully aware how influential larger systems are to vulnerable clients.
The recession is having a large impact on individuals. In March individuals on Washington State general assistance for unemployable program will no longer receive prescription medication or health insurance. Individuals with chronic mental health diagnosis may loose access to life saving medication and mental health treatment. It is rumored that ADASTA that pays for chemical dependency treatment for low-income individuals will be vanishing in a few months. ADASTA pays for long-term outpatient services of the majority of PCN clients. The economic recession is partly to be blamed for healthcare cuts; however, Washington voters turned down a referendum to tax bottle water and junk food a few cents to pay for WA state health insurance. Now lives are at stake because people were not willing to pay a few cents more on their Pepsi.
The concept of system theory fits right into this dilemma. The greater economical and political environment impacts the individual. The referendum would have passed if human service professionals lobbied it publically. Instead the voters only witness the food industry side of the referendum. The CSHSE Standard 21 states that the program shall provide field experience that is integrated with the curriculum. In my core class we are currently studying lobbying to influence systemic change. I can now understand how the failure of lobbying the voters can have lasting impacts on the individual.
Human service professionals have an ethical duty to raise awareness of issues that impact their clients. I am excited to have the opportunity to part take in lobby day in Olympia. I know it can personally exhausting to use personal free time for what appears to be work. Professionals are the eyes and ears for clients that do not have a voice. It is ethical responsibility to advocate for the needs of community.
A case manager at PCN is now in an ethnical dilemma when developing a discharge plan. Do they recommend an outpatient treatment center that the ADASTA client can only access until March? Does the case manager simply find a sliding scale fee outpatient treatment center? Or do they simply not recommend outpatient treatment due to finical limitations? I would think a case manager would still make outpatient referrals and recommendations regardless of ability to pay. I’m planning to bring these questions to my cite supervisor.