Questions for discussion with a shelter monitor

Scenario 1. Ethical test. Will a monitor work by ethics?

Joe is a resident of the shelter. He comes to you and tells you that Douglas who is in the line outside your office seeking admission to the shelter is a former inmate (was in prison)./ How will you respond to Joe? How will you deal with Douglas when his turn comes?

The issue of confidentiality is of utmost importance and must always be adhered to. Discussing personal information of one client with another is not allowed.

Scenario 2. Procedural test. Will the monitor work by policy and procedure?

Shelter rules state that all residents must be inside the shelter by 9:30 pm. Doug returns and reports at 9:35 pm. What will you do?

A monitor must adhere to policy and procedure with empathy. The monitor must demonstrate an understanding of the mission and purpose of the shelter. Empathy makes the monitor interview put himself or herself in the shoes of the client without neglecting the standards of shelter.

Scenario 3. Relational test. Will the monitor take initiative and relate professionally with colleagues in the workplace?

Laundry must be washed and put away by each shift monitor. All clients’ green registration cards must be properly filed away. Kitchen tables and all floors must be clean. You arrive and find the previous monitor has washed but NOT put away linen and the stove has not been cleaned. What will you do?

A monitor in this situation must take action, i.e. put away the linen and clean the stove. He or she must be able to work and relate properly with others who share responsibilities of this office. The monitor must document the action taken in a non-demeaning manner to the colleagues in the previous shift.

Shelter encounter

She called me in the morning when I was alone at the switchboard.
"May I help you?" I introduced myself and asked.
"I wish to speak to someone in charge of the shelter there."
"Yes, I am the very person. Shoot away!" I said.

"Do you have room in the shelter for one person?"
"Yes, we do."
"What time can I come to take the room in the shelter?"
"What is your name and have you ever stayed in our shelter?"
"Oh, I thought you said you had room for one person? Is that not what you just said?"
"Yes, that is what I said. we have room for men, women, and families." I paused just enough to make the next point, "I did not say you can come in and take the room. I do not know you; I have not seen you to make that promise to you."
I went on, "There are two other shelters in town; have you called them as well? If so, what did they say to you?"
"Yes, I called one of the them and I was told they are full at this point, they cannot take me in."
If you want to come to our shelter the time to check in is 7 pm. I am here through the day. You will find me if you decide to come early."
She hung up; or should I say he hung up.

Two hours later she showed up; or should I say, he showed up. She looked like a woman, but equally looked like a man.
"I am here! I spoke to you an hour about shelter."
"Yes, I remember that you spoke with me."
"Please show me your photo identification document; I will check your shelter records to see when you were last served by us."
I saw the woman's picture on his government issued identification card. His name was on our database too.
"How do you want me to recognize, as female or male?"
"Female. Regard me as a woman."
"Okay. The government recognizes you as a man. How can I do differently?"
"I have both male and female parts; I prefer to be recognized as a woman."
"That is fine with me. Now, allow me to take this to my supervisor so that we can be all on one page. Is that okay?"
"Yes, that is fine."
"As I said already, we have plenty of room for men as well as women; these are dormitories. hat means, if we put a person in the men's dormitory he will share amenities with men. The facilities lack privacy. The same may be true on the women's side. I hope you are following what I am saying."
"Yes, I am." She, he said.

John

I will call him John. He came to the shelter after losing his abode in a nearby city. His lived with his daughter until a week ago when she was evicted for non payment of rent. The daughter went to live with her mother, John's ex-wife. John had no place to go, no friend, no family or church to talk to.

John spent the rest of the days and night numbering 10 under a bridge as homeless. That is when a passerby saw him and told him about the Salvation Army shelter. He came and found a bed.

John is a truck driver but in the last fw weeks has not been able to work because his left arm is in much pain at the shoulder joint.

I sat down to see him in the evening of day two in the shelter. As he spoke John broke down and wept like a child. "I have sunk so low, I never thought anything like this could happen to me." He said between th sobs.
"I am not able to take care of myself. My family is not there for me. When I tell them my situation they tell me thy understand but are not able to consider taking me in. I can not work becaus my arm is in pain. If I go out looking for work I am told I can't be hired because I am not able to lift more that 5 lbs."
Then John told me what happened last night.
"I could not sleep. I had these loud noises in my head. They told me to end it. Get a gun. Find a rope. But I told myself that was not the way. I told myself I will make it. I knelt down by my bed and prayed to God. I asked God to help me, to bless me this day. I prayed that He would take me out of the place where I am."
I asked him how his day went.
He repeated what he already told me, that his day was very blessed indeed. This coming Sunday he would go to the Methodist Church close by. He told me he wants to renew his life in the LORD. I told him that was the way.
I spent time praying with John. He wants a large print Bible. He is not able to read out of small print because his sight is not very good.
As I prayed with John I felt the awesomeness of the occasion. He was determined to see God. H is determined to change the course of his life.

The next day John would go and find something to do.

Please pray for me, in the name of Jesus

Today a big man came to my social services office asking for prayer in the name of Jesus. The mystery guy probably weighs 280 lbs, is slightly taller than me, perhaps by quarter a foot; I stand at 5" 10".

At first it looked rather awkward if not purely funny that a man smelling of alcohol could walk to my office by broad daylight asking for prayer. I found him sitting in the waiting room of our social services office. He looked a little disoriented but he was clearly articulate and knew what he wanted. He wanted someone to pray for him.
Initially, when I saw him he stood up and approached me directly, "I need prayer. Please pray for me in the name of Jesus," was his request.
I pretended not to hear him. After all, when did anyone come to social services office asking for prayer? Never! It never happened. Occasionally, I may offer to pray with a client in distress who seems to express the need. Expressing one's religion can be tricky and I exercise it with great sensitivity. For that reason I prefer to wait for the client to state a need for prayer.
I went away past him to the church building one hundred yards from social services building. Upon returning I used a back entrance into my office hoping that way to avoid meeting him.
As I turned the corridor I found the gentleman speaking with my colleague.
My colleague in turn said to me, "This guy is asking for a Pastor to pray for him. So I told him to wait until you returned." She said, motioning with her hand to me to take over from there. Two colleagues were standing there besides him.
"Okay, I will walk to the chapel with him." I said, indicating to the man to follow me. I walked out of the building to the chapel. There I led him to the 'penitent seat' where I told him to kneel down before the LORD.
I prayed for him in the name of Jesus Christ of Nazareth. I rebuked the devil and demonic forces for messing up his life; I prayed for forgiveness and restoration in his life and family. I prophesied a whole lot concerning him and his family and his wife. After 25 minutes of praying there I asked him to stand up and follow me out of the chapel. He was so broken, crying like a baby, his entire face filled with tears. I rushed inside the service room toilet to get some tissue paper for his face.
As we walked out he showed me the bicycle he was riding. Then he pointed to a picture of a helicopter on his T-shirt:
"I used to drive these and now I am riding this." I nodded my head in understanding, wondering what his life is like or where he has been.
Such is life, there are ups and downs. Only Jesus makes the difference that prevents the downs from becoming down-and-out. Jesus is the equalizer in life. he came to give us full and rich life. He comes in to save, restore, and bless. He protects and guides.
One day perhaps this man will return to tell me what happened. I took authority in the name of Jesus; I bound the powers of the devil in the name f Jesus, and I released the working of the Holy Spirit in the life and family of this mystery man, in the name of Jesus. See this video: http://www.youtube.com/watch?v=cF_gJgILBiE

So, what exactly do you do as case manager?

Finally, today, April 24 and nearly 10 months since I took up the job of case manager, a client asked me, “So, what exactly do you do? ... what do you mean you work with me?” The question sounds so personal when a client asks it this way.

     This question goes to the heart of who I am, why I am here, and why I do what I do, the way I do it. I have probably said it many times already in different ways. This is different because clients do not generally ask these kinds of questions. I was caught unawares by the client and I had to give my honest and sincere answers through a conversation.

“I am your friend and advocate; the person who listens to you, to hear what you have to say ...as to why you are here in the shelter; where you want to go from here, what you want to do ...now and in more generally in life, and to find ways by which I can be helpful to you.” I explained.

“Do I make sense?”

He nodded his head and went on to ask, “So, what more can you tell me about your work?”

This sounded to me like an educated question asked by someone who knows something about this work. I gently sat back in my chair to search the vocabulary of case management studies that I did over four months earlier to come up with appropriate details of what this work involves and what I do.

“The client is the most important person in this work. You are the client and I am your case manager. I might have some good ideas for your life, but I cannot tell you what to do. Most of the time I will ask you questions to clarify your own direction in life. The main thing is that it is all about you; you are speaking to me and I am listening. Together, we are doing.” I explained.

“Are you a counselor?” He said.

“Not exactly a counselor. I am a steward. In this kind of stewardship perhaps 10 percent of what I do is counseling. The major part of my work is advocacy. An advocate is like a lawyer. I am not a lawyer. In a major way I function as your advocate, knocking on some doors for you, pointing you to social service organizations and human service resources available in organizations locally and beyond.” I explained.

He nodded and said, “Okay, now I understand.” He nodded his head some more.

I continued to explain, “You can look at me as your friend while you stay in the shelter. If you encounter challenges during your day out while looking for a job, give me a call so that we can talk about it. If you anticipate problems, for instance you are delayed by some unforeseen circumstances you can call me so that we talk about it. I will listen to you.”

"Your success is my success. Your success today is a milestone for tomorrow. Your milestone today is determined by the goals you set for today. Equally true, your success in future is determined by the goals you set for yourself."

     Many case managers are social workers and nurses; however, a case manager is not a social worker; neither is case management nursing. It is a relatively new system in terms of how to define it. Although case management has been practiced by many people in some ways, only recently has this occupation been given meat and bones to bring it to full life. 

     Even then, many times people refer to case management when they are talking about one of a nurse's tasks of nursing care. Case management is a collaborative process involving many human service organizations. At the center of this system is a client; the case manager's role is helping the client access the services available to him or her.

     A good case manager has a deep understanding of human needs and human services available to clients, is aware that some of the needs of clients cannot be fully met; is compassionate and prepared to show it by doing what he or she can for the client without dis-empowering the client.

     Nursing care, counseling, funding, sympathizing, advising, and psychotherapy are some of the traps a case manager faces. Case management is not one of these; it is at most a small fraction of some of these activities. Many clients have the wrong impression that a case manager is there to solve the client's problems; others think the case manager is a counselor and adviser to tell the client what to do, or perhaps that the case manager is a sympathizer who feels pity for the client. This is why it is important to draw boundaries and define expectations in the first meeting with the client.

     In my experience, the case manager is misunderstood by clients as well as by other professionals who do not take the time to ask, "What exactly do you do?" I have encountered some problems relating with some colleagues who are surprised when I seem to side with the client as if I am making a stand against my own organization. Such colleagues either forget or are ignorant of my role as advocate for the client. I am expected to stand for my clients and to fight for their rights without compromising my organization's integrity. 

     Of such I am one. My background is in medical laboratory sciences. I worked in the blood bank and general routine medical laboratory, taught hematology and blood banking in colleges of laboratory sciences for 20 years, and I worked as a manager for community health and development systems in rural Africa for more than five years. I have deep Christian convictions and faith in Jesus. As a soldier of the Salvation Army, case management is one more example of how I can exercise my faith in Jesus. My uniform has two S's; one on my right another on my left. The one says Saved, the other: to Serve. SS: saved to serve.

     A good case manager has a deep respect for the organization he or she represents, understands the ethos and positions of the organization vis-a-vis human needs and human services available to clients, is aware that no one organization can meet all the needs of every client; remains sensitive to organization needs and is prepared to show it by doing what he or she can for the client without discrediting the organizations involved.

Serving the homeless

My service in the homeless shelter started with a bang.  I arrived on day 1 and went to work at the frontline on day 2. I wanted a tour of the city and to meet the people involved in the shelter. I felt as though my work would be ineffective otherwise. I was not about to be given my request.

To this day I reflect on the question, “What training can one undergo to prepare adequately for such a vast array of human needs represented by the homeless shelter?” I still do not think there is one-fit-all outfit.  Maturity, a sense of independence, personal and family achievement, compassion, and a deep sense of good and quick judgment are the pre-requisites to case management. Add to that list, knowledge of the social services available in the area and a willingness to advocate vigorously for the needs of clients. Top that list with a supportive team and work environment.

I came to this job with a history of work as a manager in hospital settings, in community development, and multi-cultural setting. That training and experience empowers me to see people for what they are, and to connect with any race under any circumstance. The experience prepared me to deal with authorities in the boardroom and children in the playground and to shift between these poles as the need arises. My primary training is a medical laboratory scientist in the field of hematology and blood transfusion.

The training of hematologist and blood transfusion specialist is inadequate because it does not bring you close enough to people. The training of a manager is inadequate because it focuses too much on outcomes. The training of a social worker is inadequate because it focuses too much on the individual coming through the system. Nursing care is inadequate because it focuses too much on the recovery of unwell and a priest would be inadequate because he or she focuses too much on the faith. Case management looks at everything holistically and evaluates the options available while protecting and maintaining the integrity of the person at the center of the process.

Case management involves listening to people in need, deciding what the need is, having a good map of human needs, social services, and service providers, and the means to contact those service providers. Case management is a partnership between the case worker and the person in need to imagine a future where the person in need has moved internally to be stronger and externally to access resources necessary to make the most of the circumstances around him or her or her family. The case manager lives with the full knowledge that some problems cannot be solved and therefore suffering can only be mitigated. The case manager knows fully well that the causes of some needs are deep in the genes and cannot be cured or changed by treatment.

The field of human needs stretches as far as the eye can see; is as deep as the generations of people who ever lived. Society has come up with strategic approaches to human needs such as to encompass the most ordinary and common issues individuals and families encounter including shelter, food, health, and the need for clothing and security. Maslow devised a scheme to describe these needs.

Anyone can become homeless. In the homeless shelter these needs often converge. Dealing with homeless clients one has to learn to pick battles carefully and to pick focal points quickly too. There is no single most important point to focus on. Each person's unique circumstances must be considered.

In the shelter you encounter every shade of humanity, the broken and the breaking along with the entirely whole whose only need is space and time to make adjustment. In the shelter you encounter the emotionally broken and the spiritually uplifting. As case manager you receive some desperate calls for help. Some needs are addressed outside the four walls of the shelter through the telephone. Many more are worked out slowly and often painfully through life in the shelter.

As case manager I quickly learned one truth, no two cases are the same.  Another truth is that there is no such a thing as tough love. Every person walking through the doors of a shelter brings his or her own energy and story, and often many stories at once. Backgrounds are different; those differences are magnified by racial and ethnic diversity. Nevertheless, trust must be earned by the case manager, quickly, and love shines through no matter how long it takes; love never fails.

A few individuals try at least in the first few hours of contact with a case manager to weave their way through systems by forging stories that never happened in reality. Many who have told half-truths say it is a survival instinct, the human capacity to create fog in the mind of others (in this instance, the case manager) by which the liar can gain advantages he or she would otherwise be denied.

First interviewee

My first interviewee was a single young mother who fell out with her parents and ended up seeking shelter. She impressed me as someone that wanted to tell the whole story but held back because I was a stranger and unskilled in my trade. She hesitated in answering my questions and I did not know how to deal with that.

My boss was sitting next to me. She knew I was nervous speaking to this young woman; what she probably could not know was that my insecurity was due to the fact that I was using her questions instead of my own. They were not my questions; I went on with great difficulty and rather awkwardly, asking and jotting down some notes. Between asking and writing I was taking too much air out of this interview. I remember saying, “Obviously you do not want to talk about the fall out with your parents,” to which she quickly and vigorously shook her head sideways.

Sometime along that routine I looked at my boss and asked if she had other questions.

Clearly I was uncomfortable and did not know what I was doing. I was lost in the process and whatever map I started following I did not know where it led to. My boss asked a few more questions and let her go. Left with my boss, she turned and told me, “You never know, perhaps half of the stuff you heard was false.” I was stunned. It took many days and more interviews to realize the full significance of that statement.

Second interviewee

My second interviewee was a middle-aged man who recently came to the city from Houston Texas, hoping to start a new life. All he wanted, he told me, was to find a job and save enough to rent a house. Two days later he would disappear without notice.

This picture would repeat itself many times over the weeks as individuals coming to the city came to the shelter saying they hoped to find a chance to start over in life. At first it seemed strange that a person would live a State like California or Florida to come to Oklahoma to a small town like ours to look for a job and settle for life. I got used to the story-line.

My second interview was far better than the first. I was better composed while speaking with the man about his family situation and future hopes. Many of the questions I asked were carefully thought out: What work background do you have? Are you on treatment of any sort, physical or mental illness? Are you able to work? What questions do you have for me?

There is no strict order or sequence by which questions should be asked in the first interview although there are general issues to consider. The first contact the client has with the shelter is through the shelter monitor who initiates the intake process. That process takes place in the night soon after dinner. The monitor finds out if the client is on our database of clients who stayed in the shelter in the past.

The intake process is rigid and follows a couple of steps of filling out forms and answering a few questions about the client’s wellbeing and allergies. Instructions are given about life in the shelter: time to leave and time to come in, meals, and discipline.

The client is allowed to rest and instructed to see the case manager the following day. It is the case manager’s first meeting with the client. This is a very important and in many ways decisive meeting when the client’s future in the shelter and beyond is decided.

The case manager receives the client, greets, and engages the client over a fifteen minute or longer conversation. The case manager is evaluating the client’s total body language: demeanor, step of life, response, and lean, story and narration. At the end of this interview a plan of action is put in place which includes day 1 in particular what the client will do for the day. It also maps out a strategy for the bigger part of the client's future: what does the client want and what steps does he or she need to take to fulfill the wish? This is the process of goal setting. ALthough the case manager is a key player he does not tell the client what the client needs to do to achieve his or her desired goal.

This is where things quickly get very complicated. Some clients are in a state of shock from the cause of their homelessness, and a few others are mentally disabled. Still others have taken drugs and are not functioning normally. Occasionally a case manager encouters individuals with multiple issues.

These individuals add to the list of woes for case managers who try to solve clients' problems especially of those who are already living a nomadic life, not wanting to settle anywhere in particular.

A 78 year old man came into the office; you could see every muscle in the neck and in each leg as he worked hard to take the next steps. Evidently he needed a nursing care home. The shelter would kill him. Another person came in the hands of Police officers, unable to keep himself from falling. We learned later that he was not sick; he was stressed by the magnitude of the change that made him seek shelter. He kept saying, "So this is it? I am homeless now!"

Read more later….