Friday, May 25, 2012

Clients who don't fit in........

I've probably talked about this a little bit before. I'm talking about it again though because it came up again this week.

I'm an Intake Coordinator at work. The main parts of my job, are bringing clients onto the program and either helping to stabilize them in the community, or get the services set up for them upon their community discharge to ensure they will remain stable in the community.

Because I work at a for-profit, the bottom line is to make money. Since my agency wants to make $$$$, we often will take on clients that no other provider wants to touch, especially if a large amount of billable service hours come with the case.

Since we are so large, and take on so many needy clients, we can also afford to have a lot of highly dedicated, educated, qualified staff who are great at what they do, and who can handle some of the tough ones.

However, on occasion, a client will come along who is just not safe to serve in the community, no matter how many hours come with the case. When this happens, I am the one who generally has to be the bad guy, telling them that our agency cannot service them.

If I feel they are actively using drugs, have a lot of skilled home care needs that surpass the level of care we can provide, have a bunch of recent felonies that would make it almost impossible to secure them needed things like housing or if they let me know right off the bat they are not going to accept the services or supports I feel they need to ensure their (and staffs'!) health and safety ........I have to be the bad guy.

We've also had a lot go on lately with some cases we already serve, where one or two people end up sucking the life out of their staff (to the point they neglect their OTHER cases) so because of that, I am needing to start to get a little bit discretionary in who I choose to bring into our agency for care.

On most some occasions, I have to say, our whole office let's out a whoop of glee or Pizza for All! when we can turn down a case that we know would be a potential skull's head.

However, in all seriousness though, it sucks all around because as a social worker, I feel that everyone should be given a chance, and that often when a potential client is in the midst of a crisis even if it's been going on for the past 10 years, it takes good people who know what they are doing, to give them a chance to get back on their feet.

It also is bad because I KNOW that it's very difficult to find these types of clients the help they need in the community, and if they are continually turned down for a program, it makes their situation even worse.

I also am sure that some of these people who are turned down for support are the one's we also read about in the media.

I am grateful that the decision is not only on me though. I usually consult with my supervisor and one of the nurses before I tell someone no.

I wish I could wave my Social Worker Magic Wand and instantly fill in the gaps in our program that make it impossible to serve everyone.

At the end of the day, I still need to remind myself that I can't save everyone, even if magic WAS involved.


  1. It is always a bummer being the bad guy. But it is interesting reading about the role you play and how your agency works, it sounds really frustrating sometimes, but it must be so rewarding when you help people and realize the difference you've made.

  2. I'm interested that you mention your agency considers clients who are active drug users as too difficult to serve. Just out of curiosity (and I realize you are only the messenger here, not the one who makes the rules) does your agency have a policy regarding clients with Concurrent Disorders (mental health and substance abuse) I think it's usually called Dual Disorders in the US. Do they have a harm reduction framework?

  3. We're not a substance abuse provider; we are a home care agency. Not only that, but the program we provided services under has all clients sign a contract that they will not engage in any illegal activity. Most of our clients require staff with them for at least several hours a week, which would be problematic and unsafe if they are using. There is a substance abuse component to the program, but no providers who do this, at least in my area of the state. We often run into difficulty "proving" a client is using, especially if their door is closed (their right) and staff smell marijuana ;). Which last I checked is still an illegal drug........It's tough all around in these situations.......

  4. P.S. I have heard of "housing first" kinds of programs, but we are far from being one of them.

  5. P.P.S. One more "fun fact" regarding the housing piece: Our clients find housing all over the place, in regular buildings and apartment complexes where you, I and the general population also reside. They sign regular leases and must abide under the same "rules" as everybody else.

    1. Interesting...
      The program I work in is "supportive housing" so clients reside in mixed housing (like what you describe) receive a subsidy on their rent and agree to meet with me at least once a month for mental health support (typically much more than this, although maybe lower level of intervention than what you describe).
      It seems a compromising position to be put in, that your staff may have to "prove" drug use. We are not exactly housing first either, but generally it is accepted that I am not there to enforce good behaviour, or get them in trouble/cut off if they are participating in something illegal. If they are doing something that is putting their housing at risk, I can advise and offer support or resources.
      These are the ways that clients fall through the cracks, right? When they need the most help, but providers are too scared or ill-equipped to offer it. I guess this is the basic idea of your title "clients who don't fit in".

  6. Exactly. Part of the philosophy of our program, is that clients have the right to make a decision, even a bad one. We do our best to educate them, but in the end, it's their choice. I also personally am very judgmental when it comes to things like substance abuse so have my own opinions about what should/should not be allowed, especially with dare I say the tax payers' money?! Other social workers and human services staff can be more flexible, but that's why it's usually good to work amongst a team of qualified individuals ;).