Client Profile Debate: Unethical Actions of Case Manager-The Development of a Behavioral Inferno through Neglect. (Part 3 of Person-Environment: Case Worker Neglect)

By: Paul Goree

It is up for debate if two case managers of a mental health organization made unethical decisions, by neglecting to intervene. The mental health organization was awarded a housing grant, through a special division of HUD. The grant is for assistance with housing for eligible clients. The mental health organization administers their own housing for their clients, mental health services, and substance abuse. The grant is a formula grant awarded after approval of Consolidated Plans to cities and state with, populations over 500,000 and meet the specific percentage requirement of categorical targeted population. In other states the award is administered through non-profit categorical organizations, state/county housing departments, etc. The recipient are referrals and not necessarily clients of the mental health organization. The following are the profiles of two clients, who experienced duress (through no fault of their own) the results of two neglecting case workers.

The two clients, both referrals for transitional housing, leading to a self- sustaining/self- determinate life. The two incidences detailed, occurred and now can be reviewed to see where improvement to social service and case management can be made. Also improvements in grant issuing for programs that address independent living, transitional housing, co-habitation, and how effective and efficient the contractual administration is reaching the targeted population. Obama has made appropriations to balance the budget, and in doing so has set up committees to probes into grants issued to organization that administer multiple services and their effectiveness. In the 2013 Fiscal Budget, the White House concluded to increase efforts to “…identify programs that were either ineffective, duplica­tive, or outdated and thus needed to be cut or consolidated (p. 25). I hypothesis that the following events would have been prevented or minimized, had the mental health organization involved, was not administering multi services, and attempt to administer a categorical formula grant, of which the organization does not directly administer services for that targeted population. The categorical grant was awarded for housing, not mental health.

CLIENT ONE PROFILE:

Age: 44, African American, transitioning from chronic homelessness, current returning college student, recovery from sub-stance usage (Faith Based Treatment 2007-2008), Group Substance visits. Client has no felony charges, one misdemeanor charge and is not on probation. Clients Program objective is correlates to current behavior: Objective, finish education obtain BSW/MSW, pursue administrative policy advocate position dealing with homelessness and veteran services. Client started housing program July 2012. Client maintained successful program objective while residing with roommate (also client of program) for 5 months. At the end of the 5th month, the roommate’s programs eligibility had expired and a new roommate moved in (Client 2).

CLIENT TWO:

Age: 24, Mexican American, transiting from family into program, no education obtained (considering GED, but not registered), current substance usage (program objective treatment to follow), Client has felony charges somehow over looked/neglected during assessment. Court record detail court dates. Client has SMI diagnoses. Client program objective: successfully complete treatment, apply for Social Security, obtain GED, and obtain self-sustainability.

The following two incidences, represent the obvious behavioral differences between both clients. Which was a barrier in their attempts to successful complete program objectives. As detailed in prior blogs, there is a definite factor which must be contained in social service administration that assist in self-sustainability programs. That factor is environment. The environment is a major contribute to the success or failure of a client. Both Dr. Jeffery Schwartz ,Carel Germain and Alex Gitterman provided researched evidence that dysfunctional environment hinder the development of self-sustainability. The following two incidences, the duress and undue guilty of client 1, brought on by client two. As client 2 went through frequent personality changes, server anxiety attacks and substance abuse (of prescribed medication and street substances). These incidence were numerous and resulted in police calls, yet no intervention from the two case workers involved. These incidences continued for an 8 month period, from November 2012 through May 2013.

INCIDENT ONE: January 2013

Tension in the apartment was extreme. Client 1 accused client 2 of stealing his laptop. And provided a picture of client 2 stealing the laptop. Client one was frustrated with client 2 constant disrespect of his private property and space. Client 2 had an annoying habit of intruding into client 1’s room, even when the door was closed. Client 2 explained his intruding habit as natural cause associated with his SMI diagnoses. Client 1 not fully knowledgeable of SMI and behavioral actions, rationalized his tolerance of clients 2 intruding habit as enduring strength, by which an individual empowers themselves and ability to assist through acquiring patience and tolerance/understand individual behavior. Client 1 was incorporating spiritual aspects of human interaction into his life during this time. Such therapist and speakers as Wayne Dyer and Dr. Ellis thought of action prevailed to client 1. Thus he was extremely tolerant of client 2 antics.

On this particular day client 1 as usual retreated to his room with the door closed, hoping it would signal private time. Client 2 as usual followed client 1 open his door and walked in. Client 1 verbally informed client 2, that he was not welcomed and that he wanted to be alone. Client 2 blurted out that he was emotionally duress and needed to talk to someone about an abuse that had occurred to him in the past. Client 1 informed him that he needed to talk to the case worker or to a professional counselor if it was regarding anything personal dealing with emotions and abuse. Client 2 became irritated and stated that he wanted to talk to Client 1 about the incident, and that he didn’t find it useful talking to his caseworkers about his problems. He wanted to talk to someone like client 1, hoping that a better understanding could be found. Client 1 informed client 2, that we was unable to assist him with counseling and again urged him to talk to his case worker for a referral. Client 2 as usual disregard the entire conversation and purpose and began detailing the events of a sexual abuse from a prior boyfriend.

Client 1 interrupted and informed client 2 to stop requesting assistance, seeming he was not qualified to assist and did not think it was appropriate considering NASW. Client 2 attempted to convince client 1, that this was a friendship conversation not a therapy conversation. Client 1 then reminded client 2, that he should not take it personal, but he did not consider client 2 a friend, and that the purpose of this housing program was to become self-sustainable, not make friendships. He again requested client 2 to seek advice from a professional and not to involve him in his personal life, in reference to counseling or advice. Client 2 became enraged and began to insult client 1. “What type of case worker are you going to be? I feel sorry for the people you counsel they might end up killing themselves?” Client 1 apologized and attempted to calm client 2. Client 2 insisted on client 1 hearing the abuse details. Client 1 again, asked client 2 not to request advice and that if he continued to disrespect him that he needed to leave the room. Client 2 refused to leave client 1’s room, so client 1 left his own room, by which client 2 followed. Client 1 then ran back into his room and locked the door.

Client 2 knocked upon the door requesting entry and yelling. Client 2 then went into a serve anxiety attack and started throwing items around the house. Client 1 open the door and asked client 2 if he was ok. Client 2 ranted on as he continued to throw items around the house. Client 2 after a few minutes calmed down, then requested a huge from client 1. Client 1 denied the request, which fueled the anxiety again. This time client 2 ran to his room, ranting about client 1 stealing his medication. Client one followed client 2, and from the door way observed client 2 opening various prescribed medication and tossing them out of the container on to the floor. Client 1 informed client 2 that he was going to call the crisis team. Client 2 continued to open medication and toss them about his room. Client 1 called 911 and requested crisis intervention.

The police arrived (one female, one male). The female officer talked with client one, in the living room. While the male officer knocked upon client 2’s door attempting to get him to open the door. Client 2 refused to open the door for the officer. The officer instructed client 2 of what would be his next course of action, if client 2 did not open the door. The officer let client 2 know that he needed to make sure he was ok. Client 2 open the door, the officer saw all the pills tossed about the room and asked client 2 if he needed crisis intervention. Client 2 informed the officer that he did and the name of his case worker. EMF arrived and they asked client 1 questions regarding client 2’s prescription usage of which he could not answer. He did not know how many varied medication were prescribed to him, his schedule for taking them and how to assist if he mis-took them or over took them. EMF took client 2 for treatment/hospitalization/institutionalization.

Client 2 remain gone for a week. Client 1 started to feel bad about not being knowledgeable about client 2’s need for prescriptions and what if an event occurred where by client 2 harmed himself and locked himself in the room. How would he know? Client 1 started to feel that he should not be responsible for the attending of client 2, and that he was not qualified. Client 1 expressed to a friend, sentiment and requested information from stated friend, who is an Arizona licensed in-care taker. Client 1 wanted to know why case workers would place him in such an environment or place client 2 in such an environment. When client 2 returned, he seemed himself again. But he stated to client 1 that he is most upset that he would not huge him. Client 1 replied by telling client 2, that he didn’t feel bad about it, because he will not give him a huge ever: seeming that another associate came to the house, and client 2 requested a huge from that associate. The associate refused, but offered a hand bump instead. Client 2 accepted the hand bump in exchange of a huge. When client 1 offered client 2 a hand shake instead, client 2 insisted that it must be a huge. Thus was the reasoning for not hugging client 2. Client 2 still insisted that such behavior from a future social worker would need to be changed and that he was going to report this incident to the case worker (which he did with all the incidences).

This incident provide evidence that both clients had personal objectives and behavioral actions that were not compatible. This incident occurred month 3 of a 9 month ordeal. And at that point in month 3, represented the 15 such similar incident, with 2nd police involvement. Each police involvement ended with recognition of the organization and the case worker. Each police stated they would request intervention and the police report.

INCIDENT 2: March 2013

Tension in the apartment reached an all-time high. Both clients placed locks on their doors. Client 1 attempted to attend college course, but was often disturbed by client 2. Client 2 became engaged with a series of prior associates, whom client 1 did not know, but whom intruded upon client 1 and client 2’s household. Client 1 explained to the strangers his BSW/MSW objective and once asked the strangers, why would they want to ruin their housing opportunity? They shrugged their shoulders. He then asked them if they understood the terms of the housing agreement. They again shrugged their shoulders? Client 1 explained to them, that he was not concerned at that point about his personal housing, seeming he had lost confidence in this housing program, seeming it was now month 6 of a horrid duressful experience, by which he now desired it to be sabotage, just to see if the case workers were still alive. He then informed them, that since this was the case, he wanted to get something knowledgeable out of it. He asked them could he use their responses in any written correspondences such a report he was possibly writing for his blog on homelessness (WordPress March 20, 2013). They agreed. He then asked them if they were homeless. They responded yes. He then asked them why had they not sought shelter at CASS? The answers varied. One of them, respondent by telling Client 1 his story. He was unemployed, pending status SSD, homeless, the CASS facility was out of reach from where he was living, and he expressed a disappointment in Arizona Squatting Laws. Client 1 then asked if he had went to DES. The respondent said yes. Client 1 then asked, didn’t your case worker inquire about your homeless status? The respondent said no. Client 1 informed the respondent that DES has an entire department which focuses on homelessness. Client 1 also informed the respondent, that in the state where he recently moved from, all SSD pending clients receiving temporary housing through the county. Seeming they are either medical or mentally pending SSD. The reasoning would be, why would society subject a pending medical/mental citizen to possible endangering elements/factors, when they are ill? They might get worst. Thus efforts are made to house them, if their SSD is approved, they agree to pay the county/state back a portion of the total. If it is denied, then they are not held responsible for the total and the county/state takes up the cost. The respondent said no such program was detailed to him, and that he didn’t even know that DES offered homeless services. Client 1 informed the respondent, that he wished his class (SWU 295) which he was suppose to be attending at the current time, could hear all that he had just expressed about his ordeal and homeless as he waits for SSD.

All the time this discussion was going on, client 2 was in his room, with a few of the strangers who were not interested in what client 1 had to say. A few days following this discussion, client 2 walked into the apartment with equipment he had purchased from Cox Communication. Client 1 had already had an account with Cox Communication for Wi-Fi service only. The account was established September 2012. Client 2 opened a new account in his own name for DSL telephone service (seeming the apartment lacked the stated telephone for emergency calls) and cable television services (the only television was in client 2’s bedroom). In order for the DSL telephone to function, it needed client 1’s Wi-Fi box and service. At first client 1 had no problem with letting client 2 use the service. However on this particular day, client 1 was working on some class work on his blackberry phone, seeming client 2 had stolen his laptop. Client 2 arrived home and went to turn on the DSL, interrupting the Wi-Fi signal of client 1.

A confrontation resulted, whereby client 1 unplugged the Wi-Fi box and placed it in his room. Client 2 demanded that client 1 plug it back in. Client 1 refused. Client 2 then proceeded to go to the front office of the apartment complex and call the case workers. Client 2 returned and informed client 1 that both case workers were coming over. When the case workers arrived they attempted to resolve the problem. They did not address any of the prior 6 months of neglect and police reports, or the condition of the apartment, the welfare of the clients, simple the issue at hand. Client 2 explained the event, by accusing client 1 of not allowing him to use the cable signal for a telephone call. Client 1 respondent by informing the case managers that the cable signal is not the problem, the problem is that he was in the middle of doing some class work on his private property, with his private account that he had invested over $700 in over the past 10 months with Cox Communication, and that he did not feel he had to attend to Client 2’s disrespectful demand! Client 1 pointed out to the case managers that not only has he let client 2 use the Wi-Fi box, not once did client 2 show any appreciation with a simple thank you. He was upset with client 2’s constant plug in of the DSL box when both clients have cell phones, and that it cost him $75 dollars deposit for the connection to function, by which client 2 didn’t pay one dime. Thus in order for it to be equally shared doesn’t seem possible, seeming client 1 had the main account first and paid the deposit.

The case workers respondent by urging client 1 to cooperate and let client 2 share the Wi-Fi signal. Client 1 concluded at this point that these two case workers were incompetent and that actions must be taken to have them reviewed. A temporary agreement was made, which client 2 enjoyed, but client 1 felt was unfair. How could two case manager instruct a client as to how they need to allocate their private property against their will. This was a violation of client 1’s civil liberties (5th Amendment- proper payment of private property-4th Amendment seizing property, instructing someone as to how they will use their property is wrong and the same as seizing the property- the two case workers nor client 2 paid the bill, nor owned the property.). As the two case managers left, one of them (the female) asked client one had he been sleeping well. Client 1 didn’t understand what that had to do with the visit. She then continued to asked him was he sleeping well in the bed, seeming that organization only had funding for twin size beds and he was taller than the bed. She asked if he had to sleep in the fetal position. At that point, the second case worker laughed. Client 1 looked at them in shock, questioning the motive of such an immature statement from two professionals.