Kimmy2

     I just finished my last hrs. at six counties. I went to the recovery Summit meeting that I had signed up for. It was an inspiring event for people who struggle with mental health every day. There was of course Dr. Frese who spoke of his accomplishments in this area . There were personal recovery stories, food, gifts, and a D.J. A very nice event!

     There was one person who’s words I remember as saying that she has not recovered from her illness, but recovery is an every day challenge. I listened to her story and felt for her. This is true from what I have seen. Each day can be a challenge or wonderful, your never sure.

     Dr. Frese was a very strong willed person. He liked to joke a bit too. Like when the speaker buzzed a couple of times, he asked ”did anyone else hear that too?” He spoke of others that had schizophrenia that were of high positions, such as psychiatrists, judges etc. He also made direct comments that “we should not be ashamed”, of this disorder. He told a few stories of people who had schizophrenia who were labeled as “committing suicide”. As a Dr. his research showed that these persons did not intend to harm themselves. He stated, that if a person thinks they can fly, or that they are an angle, they might try to jump from a window;for a period of time, their mind is distressed in this way. Dr. Frese spoke of being hospitalized ten times in ten years unwillingly. He states that they tied him to a bed, and showed us pictures of this type of intervention. Dr. Frese wants people to know about this disorder, and understand it better. He states that ther are higher functioning persons that do not tell of their experiences; these persons would not want anyone to know that they had been “labeled, or hospitalized”.

       My experience has been very fullfilling, both in knowledge and communication. I have enjoyed the  group settings that are more personal, then, move to the office for the paperwork, discussion and filing. The meetings like this one, will draw individuals out. The people usually stay to their comfortable groups, but this is an accomplishment: for them to go around 250 people.

     I left at 3pm when they started dancing. I told everyone I would stop back in for a visit sometime. I had all of my hrs. in before today, but wanted to join the group in this activity that they were excited about. It was worth it.

     I gave  a small flower and a thank you card to my two therapists. They have been so helpful to me. It was a pleasure to work with them. I will now have to move on to my next learning experience whenever it will be;  when I read everyone’s stories, when I go  class next, read a book, or just at home with my kids.

Kimmy’s SOAP :

S: ” I walked into the Recovery Summit Meeting and asked where to get my name tag”.

O: Kim attended the Recovery Summit Meeting for 5 1/2 hrs today. She was very verbal with the clients, and helped serve food when needed. Kim was a little aggravated when the coffee pot broke, but problem solved by buying  a soda  instead.

A: Kim participated in the recovery summit meeting. Kim was verbally expressive with the clients as they sat down. Kim was helpful to searve food, drinks, and hand out paperwork during this event.

P: Kim should continue with her schooling for 1 year. Kim should follow her goals that she has listed for her instructor. Kim will verbally review any problem areas with her instructor each week of her program. Kim will contact six counties to sub when she is available.

This week I have been able to continue documentation. I seem to be doing this a little faster than I had previously. I don’t know if it’s because I am getting faster with typing, wording, or both.

     The clients I see, are so open to discussion. I felt that when I first went into groups, that the therapist would have to try to pry feelings out, and dig deep into the persons hidden feelings. It might be that way for a person who is not accustomed to the system. These individuals are seasoned with experience. They know what they have problems with, what they are supposed to do, or who to call for a crisis. I do enjoy hearing that a person can go to crisis if needed. I know that does not sound good, but it is important for these individuals to recognize the stresses that they can’t handle, or situations, and ask for extra help.

     There was a report I did for abnormal psych this week. It covered BPD or Borderline Personality Disorder. When I looked at the initials, I seemed to keep wanting to attach Bi Polar Disorder to them!! When I finally taught my brain to think outside the blonde box, I found this a very interesting reading material. I am actually going to give a presentation on a case study also. Anyways, what I am getting at is that I actually met with someone that had this disorder. I did not know it, but the therapist told me later when she knew I had been reading about it. I think I can learn better by attaching the disorders to someone. The words on a paper are so much different that seeing someone in person. I can see it now a little differently.

     I know years of experience in the mental health field would make a person more of an expert, and I have yet not learned all ways to apply myself. I don’t think I will be at my site very much longer as my hours are already almost met. I know that anything I have learned even though it’s the mental field, I can use anywhere. Communication is always the most important. This is used so very much in six counties. I know that I have even been applying it at home. When I constantly praise my daughter “That’s a really good job”. I do compliment her, just not as much as I am now. She noticed, and asked me “mommy, why do you keep telling me that I am doing a good job at my work”, I laughed, and knew!!

     I do think my OT skills are still at work while we talk in group. I can sit and listen to a person talk, write down their expressions, and still think of activities that would be beneficial to them!! I know when one man was speaking of wanting a wheelchair, I thought, boy he doesn’t need one, he walked better than me! He just wanted a toy that the market was trying to sell him. I listened, and I did not comment.

This week in group I had three people to document on.  I am starting to write a little faster, and that makes documenting go quicker.  Specific wording like “facilitated Goal review” is becoming more fluent in my documenting. I notice also that there needs to be a balance to writing, and listening.  In my determination to write down important things said, I don’t want to seem like I am ignoring someone. If  you ask someone a question, you have to listen to their comments, and not just write. The therapists are expert already, and it is more natural to them. I think when you know your client, you already have a set expectation as to their reactions or responses. I try to write quotes alot too. My supervisor explained that quotes are an “excellent” notation  in their documentation.

I also have a new way to encourage a person to talk. You have to “prompt” them with words of interest to get them to respond. If you have a group member that has not opened up, you just speak directly to them. You might “involve them” by asking them to reply in the conversation. I like to prompt people.  There was a quiet girl in the group. When I heard that she had five cats, I mentioned to her that I liked cats too. I asked her what their names were, and open up and told me. The importance of having a good support system,  is reviewed frequently with our groups. This aspect can be carried to all areas of our field, not just mental heralth. It is important for clients to have that “shoulder to lean on” when needed.

O, I did something wrong too. Someone asked where I live. I stated “By the Inn Place”. My supervisor told me afterwardss that you shouldn’t give out that information. She used to work in the prison too, so she is more familiar with dangers. She  said most of these people are harmless, but you never know. It is safer to just say “In town”. I did get one of the clients to hum me a song. We went for a ride in the van one day. The therapist has a medical book with her when we go somewhere. We stopped at a park for a walk; most enjoyed, some wanted to go sit. It was a beautiful day.

There were discussions of electric wheelchairs one day. I think the people who sell these are like telemarketers. They will send you one free if the insurance does not pay. The clients were all able to move around well. I could see no need for a power chair.

I was present when a client stated theat they wanted to stop coming to groups. When he left, there was a discussion of how to process this. When a person leaves their group, a SOAP note is made out. I was not present for this part of his paperwork, but will end my blog with my own notation of this.

S: Client walked into facility and stated “I don’t want to be in the group anymore”.

O: Client seemed distressed or agitated as he entered the room. Client was aware that the group session was ending, and came in afterwards.  Client verbally expressed a desire to quit his group. Client listened to information concerning being exited from group. Client listened to encouragement to reconsider his decision. Client stated a decision to exit his group after a few minutes of thought. Client verbally acknowledged the process, turned, and walked out.

A: Client has missed the last three weeks of group sessions. Client was spoken with and encouraged to attend his groups for support.  Client was informed of procedures of being exited from his group.  Client was given encouragement to recosider his decision. Client still expressed a decision to exit.

P: A SOAP note with summery will be submitted for termination of group. Caseworker will be notified of clients decision to exit group. 5/14/09

I had a very enjoyable week!   My experience in the documentation area is getting better at six counties.  My supervisor said she could use the ones I did.   I take much longer to write a note then the therapists do  though.  I think after you have done them for awhile, it becomes second nature.  My notes are shredded after I have wrote them.  The one thing that I can’t get used to, is writing for a different day.  If I didn’t have exact notes, I don’t think I could remember everything that my 2 clients did or said a day or so later.  When I worked at the other places, we did them right away!

  I know one hard thing that I feel will be a problem is that these clients can get attached to you.  I have a couple asking how much longer I will be there before I go.  The one thing that did make my week was that my supervisor asked if she could give my name to her supervisor for a substitute.  She said my documents were good, and I interacted well with the clients.  She asked if I might be interested in speaking to the group about something with O.T.  I will need to follow up with Amy or Mary on the subject before I do.  I was just so excited that she liked my writing.  I know, just as Amy stated, it is different everywhere you go.  If I handed my note to say Charity’s “Steve”, he might hand it back and tell me to try again. 

My supervisor and I did do an assessment on someone, and she spoke with me about conflict of interest.  If the person knew you, or your family, or you knew them or their family, it would be better for another person on the outside to treat them. I don’t know if that only falls in the mental health field or not. 

Kimmy2

“Auditory Figure Ground” was used by Amy in lab this week. I glanced over the term today after I gotten home. I like to try to absorb new terms and meanings by associating them with something; I seem to retain things better with this method of study. As Amy’s term absorbed itself into my thoughts, I attached it to my fieldwork group(Six Counties). Most all of these clients have been diagnosed with Schizophrenia, some with compound disorders as well. They might hear many voices. Amy’s definition was ” listening for one voice out of many”.This is especially a struggle for mental health as they cannot sometimes focus on their own voice, others speaking, or voices in their mind. I am told there are headphones that simulate this effect with voices to get this experience. I have not tried them. You might also better absorb the feeling as I did when in my interview I asked ” where would you love to go, pick anywhere”? ” Hawii” was the answer. I smiled and pictured beautiful beaches, exotic flowers, and an abundance of food; tan bodies lay on the beach as children played in the waves. Sunshine beams warmed your face as your toes wiggled  through the sand. But no, the thoughts I pictured were not what the client saw. They instead envisioned strong waves and current smashing wildly against the rocks. “Why” I asked; so the voices cannot be heard.

Progress note narrative:

I am feeling very comfortable with the clients; they are all very accepting of me too. I finished my interview, and was very pleased with the progress. After I had finished, I thought of some other questions, but didn’t want to pry. My progress is well at this facility. The paperwork seems overwhelming at times. I don’t know how they keep up. I am trying to understand each area of mental illness. I am looking up some things, and asking questions. The therapists know each of their groups well. It works well that way. they know who is having a bad day, good day, quiet day etc… I can appreciate that we need to know our clients, and how their day might be.

We had our regular group meetings this week. The clients are very comfortable speaking out about their feelings. I am going to write today about my interpretation of the Quinn Bash I attended on Friday.

First a little history. The Quinn’s have a son who has been diagnosed with a mental disorder. Tom and Margaret Quinn are officers of the Local Alliance for mental health. They provided a comfortable atmosphere with food, music and dancing. The party was a type of celebration that was open to the public, and free. The event attracts family, friends and professionals from the six county area that deal in mental health. The celebration provided 3 hours of relaxation for those who struggle with mental health. The Quinn family members included 7 children and a few grandchildren who sang and played instruments. Pat Quinn states “This party is really about celebrating recovery from mental health illness”. There were over 250 people who attended. I had a wonderful time. I was even asked to dance from a few of our group members. It was nice to see the community involvement. as you looked around, the smiles and laughter touched your heart. I felt bad as I thought of the times I had looked at someone and judged their behavior; not in a mean way, but putting a barrier up. You see, I am afraid of the unknown. These people deal with “the unknown” every day.

I am also planning on attending another function that deals in mental health. The speaker is Frederick J. Frese, Ph. D.. He is a psychologist with 30 years in mental health. He was also diagnosed with schizophrenia as a boy. There will also be personal recovery stories during this event.

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Initial note:

Type of Service:

Mental health awareness

Activity / Topic Interaction:

Quinn Family Bash, April 17, 2009, Zanesville Welcome Center 1-4pm

Goals / Objectives:

Mental health awareness, and a celebration of community with mental health.

Therapy:

Singing, and dancing with encouragement to participate. Prompting the public to interact and accept mental health patients. Encouraging those who struggle with mental health to relax and socialize with one another.

Response to intervention:

Every person seemed to enjoy this party. There were many who danced and laughed; others nibbled at snacks provided. The atmosphere provided a joyful response from all.

Bless the Quinn family for extending their lives for others!

I sat in group sessions this week. The sessions contained around 8 clients. They are 3 hour sessions. I started my paperwork this week. I was given progress notes to practice on. These notes are completed after each session, for each client. I will post one at the end of my blog for my initial note. The paperwork seems more overwhelming than the sessions. I am not the only one, the therapists are overwhelmed too. The progress notes are made in a certain fashion also. I need to adapt my style of writing to this manner.

My other experience was assessments. We documented two on Friday. These are on an individual basis with review of medications, history, family, living arrangements, and yes, did they have any suicide thoughts. I was suprised at one “yes” responce. Not that they had them, but it was asked what the plan was. If there had been a specific plan, they would have been flagged to go into crisis for immediate care or hospitalization. If it was just thought of now and then without a plan, it was noted. One of the clients we met with was considered dangerous. You should never have only one therapist in this setting. It was good to know the chart, and be prepared for possible outbursts. Everything went well. I did make a suggestion to the therapist that he could use a ball to squeeze during group to have someplace to assert his aggressions. I believe she liked this idea, but did not have anything. She asked if he could maybe use a tennis ball. I wasn’t sure if that was good, because it did’nt give at all. I don’t think they have all of the therapy toys we see in some settings.

Initial Note:

Activity/ topic/ interaction:

 Client government meeting with speaker S.H. who reviewed services provided to identify strong and weak areas clients identified with.

Goals from Client:

Will manage my symptoms. Focus on topics in group sessions. This will increase my listening skills and impulse control, off topic comments, interruptions, and talking to others.

Therapsutic Interventions:

A client government group was held. J was given opportunities to express concerns during the meeting. J was encouraged to participate in this structured activity that allowed positive interaction andpromoted engagement in decision making. J was encouraged to join in discussions of the easter basket drawing. Setting with speaker allowed demonstration of self controll. J was prompted to express concerns during this meeting.

Response to Intervention:

J werbally expressed likes and dislikes during client government. J was able to control verbal expressions while others were speaking in an orderly fashion. J spoke in a positive manner when expressing the easter basket drawing to me. J expressed verbal and writen feelings to the speaker during this session in a positive manner.

Functioning:

Mood:   X Anxious

Affect:  X Full

Behavior:  X Impulsive

Cognitive Impairment:  X none noted

Please note that there are more functions listed, I just gave you the first few.

My first week at six counties was alot to take in. I guess you all know that I am not to shy in the area of expression or questions. My experience this week was with group therapies. Each group was in a different catagory according to their diagnosis.  The people seemed to accept me after I was introduced. I was afraid that they would not want to talk much. I was wrong. They were very expressive. One obstacle that I need to overcome is a “well Known” problem. I talk too much! I need to learn to listen more. The therapist sessions are to hear the voice of others…not mine.

I also attended a group counsil meeting that was run by the patients. This was a nice way to delegate responsibilities and expression. I enjoyed this. The clients had been collecting food to give to the needy. They took a vote on where it should go. You wouldn’t think that persons who had so many problems already under their belt would want to put in this effort. In our busy everyday lives, we often don’t take the time ourselves to do such . It made me feel like donating too. I looked around at their proud faces and felt their joy.

I visited the “in place” also where clients were in charge of the programs there. They had a phone line called ” warm line “, where people could call if they were sad or lonely. I think this is a wonderful program where clients have responsibility.

If I could say there was one thing I appreciated most this week, was that ALL have something to give!

Initial note-

I met with the therapist. we reviewed the facility and my goals. I observed behaviors in three different group therapies. Documentations were done after each session. I was given a blank form to fill in my observations.   Each therapy sessiomn lasted 3 hours.

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